Friday, December 7, 2012

12 Areas of Risk in Your ICD-10 Project

As payers and providers progress through their ICD-10 project, some common areas of risk will become obvious.  Whether you’re a payer or a provider, the following are some common areas of risk that should be considered along with some ideas for addressing their mitigation.

Area of Risk
Possible Mitigation Approaches
Providers not ready
Outreach. Survey/questionnaires. Develop contingency provider support plans.
Payers not ready
Outreach. Survey/questionnaires.
Identify your metrics. Establish a Workgroup. Test your approaches against your metrics.
Configuration (payer systems)
Utilize a coding specialist to review benefit and contract configurations. Develop tools and methods to assist with configuration changes.
Trading partner Readiness
Surveys. Establish a dedicated workgroup
Inter-dependencies with other systems and procedures
Hold regular meetings. Communication. Ideation of workarounds.
Missed areas
Survey end users. Require formal signoffs from business area leads.
Establish a dedicated team. Employ the use of stubs to enable early end-to-end testing.
Payment Modeling. Encourage provider-payer collaboration
Vendor readiness
Surveys. Repeated follow-up. Collaborate with other users of the vendor’s product(s) Lobby for commonly needed information!
Resource availability
Project plans. Measure hours. Hire resources that can be converted to FTE after project.  Leverage internal SME’s.
Impacts from other projects
Attend project meetings.  Read status reports and meeting minutes.
Educate PM’s and SME’s of other projects as to the various forms of ICD-10 impact.  If possible, avoid enhancements and changes involving ICD, DRG and diagnosis-related information.

While some of the above risks may have greater or lesser impact depending on whether you’re a provider or a payer, where you are in the ICD-10 implementation and the size and nature of your organization, your project should have a risk assessment and mitigation plan that includes these and other potential risks.
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