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The ICD-10 implementation is fraught with dangers and organizations have to be careful with analytics tools they use in order to predict the revenue risks once the new codes go live on Oct. 1, 2014. Apart from the GAP analysis of the organization, analytics software applications which focus on reimbursements and claims (whether by the biller, insurer, provider and payer) will help identify weaknesses in the process. Just like treating cancer, early identification is crucial to the success of this endeavor. Limiting miscommunications Analytics plays an important role in ensuring a more seamless transition as well as make sense of the unstructured data in healthcare. While nobody really argues the importance of data in healthcare industry, there’s a large communication gap between what the data provides and what the physicians intend to relay. Analytics is much more than data mining, and this intelligent information is what allows the providers to anticipate diagnosis and the regulators to get better recording of a pathogen. Neutrality analytics In terms of IT compliance, there’s such a term as neutrality analytics. This covers member benefit, claims payment, operational and clinical neutrality. Addressing the gap in each component will help prevent healthcare fraud waste and abuse. What does each component mean and how can they help contain the revenue gap? - Operational analytics will limit divergence in call volume or claims adjudication. - Member benefit will help determine if the coverage will be similar before and after the deadline in 2014. - After the implementation, there should be no drop in the claims payment. - Clinical neutrality refers to the capacity of the organization to deliver the same kind of healthcare under the new environment. Beating the deadline According to the HIMSS ICD-10 playbook, the organization should be prepared to handle the expected backlog in cases, delays in reimbursements as well as excess funds in the initial phase of the implementation. In that sense, they should have enough resources to tide them over when the revenues start to decline. Small companies find this one to be their biggest hurdle in the adoption of the new codes. Working in the same page In order to at least minimize the full impact of the ICD-10 implementation, organizations are advised to test and retest their systems months before the deadline. They should work with their payers, providers and insurers to make sure everybody is operating on the same page. That means they are using common procedures and test runs in testing their systems. Communication and education are more important than ever. This is the time where internal politics is set aside so that everybody is united to work toward the common goal. The management or the committee task to handle the transition should meet with the different departments everyday if needed to make sure nothing is lost in the translation. Jvion provides complete information on ICD 10 implementation and ICD 10 Playbook
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