Wednesday, February 6, 2013

ICD-10 Topics at the Healthcare Mandate Summit


On Tuesday and Wednesday of this week, Edifecs sponsored the Healthcare Mandate Summit to bring together some of the top payers, providers and industry experts in the country to discuss compliance with multiple healthcare mandates.  Here’s some info on the ICD-10 mandate that I gleaned from the #MandateSummit hashtag 

Best Practices and Observations

1. Assess and quantify financial risk, use ROI to allocate budget and resources for...
2. Recommends holding contingency $$ at program level vs. project. Speeds reallocation
3. Budget is "lean and mean" hired a full-time project controller to manage
4. Highly disciplined schedule risk management. Deliver early & often vs. big-bang
5. ICD-10 is one of the biggest resource constraints is domain knowledge. Staff turnover and wage jumps are increasing.
6. Payer-provider collaborative’s – particularly with testing and communication - are key to success.

What happens after 2014?

Dennis Winkler from @BCBSM discussed how the effects of the transition to ICD-10 will be felt for years to come. Post 2014 is a question not many have focused on yet. That's changing.

1. Year 1-2 after ICD-10 - Stabilization phase
2. Year 3-5 after ICD-10 - Need to assess and monitor the data to ensure it's correct
3. Year 5 and beyond after ICD-10 - The time to use the data to revise fraud & abuse rules, etc.

Note: In my estimation, some organizations will start to leverage ICD-10's specificity and the information they glean from the ICD-10 data they collect starting in Year 3.  Medical policies, benefit plan designs, and provider contracting configurations - particularly in regards to quality and performance based contracts - are all areas that can be improved using ICD-10.

Prediction:

By Q3/Q4 of this year/2013, plans will start to see gaps in approach and remediation, esp. in managing legacy systems

Audience Polls

1. Only 45% have a tool/process for submitting/accepting test claims in an end-to-end test.
2. If partners aren't ready, 43% will only accept ICD-10 after a certain date; 33% will dual process

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