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The ICD-10 implementation creates both opportunities and challenges to health care providers, depending on their readiness to absorb and understand the complex codes under the new scheme. Even as early as now, organizations have to adopt a policy whether to replicate or optimize. To replicate or to optimize? Replication is when the codes under ICD-10 behave just like the codes of its predecessor, the ICD-9, for a smoother transition and also improve financial neutrality. On the opposite end, you have the optimization and this occurs when the organizations will maximize the improved precision and meticulousness of the new codes. Although both pursue different paths, the objective is the same: to achieve ICD-10 revenue neutrality. It must be said however that optimization is a huge gamble. If done right, the company can expect to reap the windfall of increased reimbursement payments and revenues. If not, it could risk a slippage in the payment total. Although there’s no right or wrong answers since the choice largely depends ont he requirements of the company. For a large hospital, the conservative choice is to replicate the system because it is dealing with a large number of historical data. For an organization that isn’t dealing with set standard prices and procedures, then optimization could be the better route. The important thing is for the organization to conduct an ICD-10 assessmen to gauge its readiness. Revenue neutrality Notwithstanding the results of any ICD-10 assessment being conducted by companies today, it’s very difficult to predict the outcome of converting into the new scheme because of too many elements and variables involved. What are these variables? You have the quality of the report, accuracy of the language or text that is inputted into the new code from the previous ICD-9, the methods used in the reimbursement claim processing, security mechanisms to prevent fraud and abuse, and even the policy of whether to optimize or replicate will impact on the ICD-10 revenue neutrality. Managing the risks Even during the assessment phase, the organization should already decide on its plan to replicate or optimize then immediate create a timeline for implementation. For a large company, it needs to break down the complex distribution channel into small tasks. It has to create a special team to lead the ICD10 implementation. Probing your own systems for any weakness should be conducted during this phase. After which, the organization should renegotiate contracts to better prepare for the transition and assess the potential impact on reimbursements for ICD-10 revenue neutrality. For healthcare providers, link up with vendors, payers and clearinghouses to make sure there’s no miscommunication in the terminologies being used. Of course, the implementation is not a one-time endeavor. The company should conduct regular monitoring using analytics to determine its performance under the ICD-10 environment.
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