Monday, August 1, 2011

Establishing a Framework for Assessing & Managing ICD-10's Financial Impact

Whether you’re a healthcare provider, some sort of payer or an intermediary eagerly serving healthcare payers and providers, the concept of financial neutrality should mean this to you:

After remediation of your systems, business processes and policies are completed, there won't be any meaningfully negative impact to your payer, provider and/or intermediate business partner's financial, clinical and operational outcomes.

While there are some subtle and not so subtle differences inhow payers, providers and other healthcare constituents will have to tweak and tune their systems, business processes and outcomes, the basic approach to establishing a framework for assessing and managing ICD-10 reimbursement impact and remediation mechanisms is quite similar and includes iterating the following:

Analyzing Your Data History

1. Identify your most common codes (create a frequency distribution)
2. Determine which of the common codes map through a GEM

Mapping Your I-9 Codes to I-10 Codes

1. Create your high-level or enterprise-wide code mapping
2. Create function-specific (or purpose-built) maps
3. Identify fallout codes and opportunities for resolving fallouts

Define and Test Your Modeling Scenarios

1. Identify negative and positive impacts to your enterprise and functional scenarios
2. Leverage forward-mapping across your enterprise and purpose built scenarios
3. Test and measure your results.
-         Compare your results to established and evolving industry “norms”
-         Tweak and adjust your scenarios with input from your SME’s before it’s too late.

Lather, rinse and repeat until squeaky clean!  Just don’t wince and retreat!

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