Thursday, July 21, 2011

ICD-10 Awareness Education & Training for Healthcare Payers

The hubbub around ICD-10 seems to be focused on the provider-side of the provider-payer equation; specifically in regards to how ICD-10 impacts clinical documentation, claim coding and reimbursement.  A whole host of education, training and awareness-building products and services are being offered (and pushed) at providers by a wide range of companies including traditional healthcare IT vendors, mainstream education/training firms, various associations like AAPC and AHIMA and even some old-school accounting firms. 

But there appears to be a dearth of similar offerings targeted at healthcare payer staff charged with assessing and remediating their business processes and software systems.

What would an ICD-10 Awareness Program for hHalthcare Payers Include?

1.     The usual overview of ICD-10 code structure and differences from ICD-9.
2.     An overview of other codes impacted by ICD-10 including DRG’s, MDC’s, and HCC’s.
3.     Enumeration and high-level review of payer business processes and applications impacted by ICD-10 and related codes.
4.     An overview of ICD-10’s potential reimbursement impact including DRG shifts and changes in case mix index.
5.     Review requirements for basic ICD-10 compliance and identify opportunities for strategic differentiation.
6.     How changes to External Codes (E Codes) impact 3rd party liability/subrogation.
7.     Review how discontinuation of explicit Status Codes (V-Codes) will impact certain processes and applications.
8.     Identify and discuss challenges and options related to ICD-10 impact to actuarial, underwriting and other financial models.
9.     Overview of mapping, crosswalk and general equivalency data sets and tools including a survey of currently available and evolving products and services.
10.   Overview of methodologies, approaches and tools that can be used to assess and remediate business processes and applications.
11.   Presentation and review of opportunities, issues and risks associated with ICD-10’s impact to longitudinal data analysis.
12.   Identification and review of commonly expected remediation patterns.
13.   Enumeration and review of automated processes and software tools that can be used to facilitate the assessment and remediation process.

What would an ICD-10 Awareness Program for Healthcare Payers NOT Include?

1.   Detailed overview of ICD-10 coding.
2.   Detailed, payer-specific consultative and advisory services.
3.   A bunch of high-priced consultants on-site for days on end.

Who would an ICD-10 Awareness Program Benefit? 

1.    Departmental managers and supervisors who need to quickly get up to speed on ICD-10.
2.    Business analysts and information architects charged with ICD-10 assessment and solution design.
3.    Software developers who’ll be performing remediation.
4.    Quality assurance and technical writers charged with validating and implementing remediated systems.

I think a payer-focused ICD-10 Awareness program would help leverage existing resources, lessen dependency on expensive consulting resources who often learn on the job at the clients expense and lead to better overall outcomes.  Who’s out there that can provide this needed service?

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