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Healthcare industry stakeholders can prepare all they want but there’s still that concern about the unknown that nags at them. They can conduct trials to test out their system or procedures and software programs can help evaluate financial readiness but there’s no fool-proof way to assess the financial neutrality of the organization after the ICD-10 implementation. Simulating a situation using GEMs or general equivalency mappings or the ICD-10 MS-DRG grouper will help pinpoint the gaps but it’s important to manage expectations because they can’t really predict future behaviors. However, there’s value in creating a hypothetical environment under the ICD-10 by using the GEMs. Adaptation Strategies The GEMs and ICD-9 to ICD-10 crosswalks are just some of the mapping tools available but they might not work for you even if they proved to be effective to somebody you know. You try to find other mapping tools or modify the GEMs to achieve the best results. Use the ICD-10 financial risk calculator to identify vulnerable areas in the claims and reimbursements. Once you identified the gaps, try to decide which areas can be influenced for adaptation strategies to mimic the present environment, particularly on the financial side. In the same manner, you also try to decide which areas which are out of your control such as the DRGs, for instance. Giving Small Orgs a Fighting Chance The ensuing costs in the migration are already a huge burden for smaller organizations. But these small healthcare facilities make up more than 80% of the whole industry. The policy makers recognized this fact of course and so they temper the need for a new coding system to be instituted to replace the 30-year-old ICD-9 to the ability of the smaller organizations to catch up. An intensive ICD-10 assessment will provide ample data that can be harnessed by the small organization to improve its readiness to absorb the new codes. Crucial Steps to Undertake Industry experts are one in saying that everybody, most especially the small organization, should first appoint a committee that is task to review the whole system and procedures as well as make recommendations in relation to the ICD-10 readiness and financial neutrality. A separate committee will handle the post-implementation audit. Nobody is going to be exempted from the expected losses in the few months of the adoption of the new codes. The ICD-10 assessment should hopefully tell the organization how much to set aside for at least six months so the company can stay liquid and absorb the full impact when it can record delayed payments and reimbursements. During this whole process, it’s important that the organization should be proactive in trying to find solutions rather than wait for the problem to crop up before scrambling for answers.
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financial neutrality, ICD-10 assessment,
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