2012 is your last chance to assess the impact of ICD10; Don't lose it.
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At Infosys, our Insurance, Healthcare and Life Sciences teams strive for holistic, better and safer healthcare through the technology we create. In this blog, we will discuss healthcare IT, obstacles, successes, new ideas and much more, with the aim of improving healthcare technology, and quality of life as a result.
December 20, 2011
November 7, 2011
Will HHS grant an extension for ICD 10 compliance beyond Oct 1, 2013?
Many commercial payers started on ICD 10 compliance activities quite early. However, based on my current visibility, a significantly large number of payers that are in the early phases of assessment are not ready for the Oct 1, 2013 date.
Following are the key issues..
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August 4, 2011
ICD-10: What goes along with Financial Neutrality?
With the transition to ICD-10, payers will certainly leverage the added granularity to improve their existing policies, adjudication rules and benefit categories. So, now certain services will be covered and paid, while others will no longer be covered and might be pended or denied if the claim is filed. These decisions will be crucial during the transition from ICD-9 to ICD-10 because any loss or misinterpretation of information about clinical issues will invariably distort the ability to ensure neutrality with respect to claims payouts. We also know that payers do leverage certain software (DCG/MEG/DxCG/CRGs) to predict their member expenditures or prospective provider reimbursements for members with multiple, combination or complicated conditions. These prediction software systems (which are all in ICD-9 as of today) will be migrated to ICD-10. Lack of clinical coherence in their transformation process will invariably alter the coverage group and risk pool definition, along with the member risk profiling and stratification statistics - all of which will ultimately impact the bigger goal of achieving financial neutrality at an enterprise level.
Please read the complete article in my blog post at ICD10HUb.com.
July 14, 2011
Financial Neutrality: Address it before the calendar turns "2013"
Even before the industry could solve the puzzle of ICD-10 mapping, "Revenue Neutrality" has become a new food for thought. It's obvious that ICD-10 will alter health plan's existing coverage determination, clinical policies, and adjudication logics at a much finer level, which can complicate their reimbursement decisions for every single service claimed by the providers. If this occurs, then guaranteeing that provider payouts remain at the same level in ICD-10 as they currently are in ICD-9 will become somewhat of a myth.
Read the complete article here.
Payment reform with ICD-10
The advent of ICD-10 has made the payer & provider industry to seek new ways for improving the management of their medical expenses. In order to achieve this, both parties will need to work together towards remodeling of the payment structures and methodologies and establish a prospective contract model that can help rationalize the medical cost structure, ensure clinical integrity, and optimize operational efficiency across organization's functional areas.
Read the complete article in my blog space in ICD10Hub.com.
March 15, 2011
Video: Healthcare Reform Today & Tomorrow- The focus areas
Video: Healthcare Reform Today & Tomorrow- The Stages
January 18, 2011
Affordable Care Act (ACA)- Healthcare for all
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December 31, 2010
ICD-10 - is there sufficient time for integration?
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December 27, 2010
Think..... Before you Crosswalk...
November 29, 2010
Clinical Documentation and Improvement Program(CDIP)....yet another in ICD-10 compliance
November 26, 2010
Future of Fraud, Waste and Abuse in the post reform world!
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October 28, 2010
Video: ICD-10: Provider's Best Friend
October 12, 2010
Video: ICD-10: A Next Generation Cost Cutting Tool
Video: Remediation Strategy Oriented ICD-10 Testing
September 30, 2010
Meaningful Use : A key enabler for ICD 10 compliance for providers
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September 24, 2010
Video: ICD-10 tactical solution - locate the landmines at the beginning!
September 23, 2010
Video: ICD-10 tactical solution - not as easy as you might think!
September 22, 2010
Video: ICD-10 tactical solution - when is it appropriate?
July 29, 2010
The ICD-10 watch game is over: Providers just can't afford to remain in the backseat.
Even realizing the overhauling ICD-10 impacts in the fabric of the provider business processes, when the time is to establish and execute the strategic transition plans, i think majority of the providers are still grappling with how to integrate the new codes throughout their business spectrum. Also the significant challenge confronting many of them is probably a lack of definitive information about where to start? How to start? It is noteworthy to mention that a considerable chunk of providers are vouching on some form of external help to prepare for ICD-10 implementation- either through package vendors upgrades or outsourcing the most vulnerable HIM piece. "Buy vs. Build" is also a viable option for many. Some are even prioritizing to stabilize on the 5010 platform before they kick start for ICD-10.
Why ICD-10 is the perfect opportunity to move away from legacy systems?
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To crosswalk or not to crosswalk?
June 25, 2010
ICD 10 - reimbursement opportunities
"ICD10 and Meaningful usages... the twains shall meet, for sure"
Deviating a bit from my previous discussion regarding provider's movement, up the EMR adoption chain, today I wanted to take a slight tangential divergence today to talk about the other big guy in the arena. Yes, I am talking about the adoption of ICD10. But is it really a tangential diversion? Isn't that the million dollar question?
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June 20, 2010
Payout neutrality using the new MS-DRGv26 is a debate...simulate your payments now
June 9, 2010
Video: Necessity of Crosswalks for a successful ICD-10 Implementation
June 7, 2010
Video: Strategies for ICD-10 Implementation
June 4, 2010
Video: Disruptive Force or a Sea of Opportunities?
June 2, 2010
Video: Role of ICD-10 in Health Reform
May 31, 2010
"Disjointed Vendor Strategy can be a blow to your I-10 planning"
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ICD 10 - spreading the investment
One health plan I know has budgeted approximately USD 100M for ICD-10 implementation. Major chunk of that money is expected to be spent in 2011. That's a lot of money for a health plan of any size to spend, on a "regulatory" program - and that too between now and Oct 1st 2013. Smaller organizations will spend less, but it will still be a significant portion of their IT budget in the next 3 years.
May 17, 2010
Mutually Mandated ANSI X12 275 is the only means for Payers to develop an agile CROSSWALK
The diversity in the nature of ICD-9 to ICD-10 coding means that the task of developing a workable translations and crosswalks is highly challenging and complex. To my opinion any healthcare organization that tries to address all of them only through GEM is at significant risk of paralyzing itself. A thoughtful and rational approach is essential to derive the best from the out of the box maps available in the GEM. But that cannot happen without availability of reference clinical data.
April 30, 2010
ICD-10 Impact: Beyond Revenue Cycle Management
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April 22, 2010
Meaningful CROSSWALK is beyond GEMs...
"With wide spread ICD-10 knowledge available in public domain, Industry today has recognized that Crosswalk is the tactical means to comply with the mandate.
In this regard, healthcare organizations have considered the CMS provided GEMs as a finite crosswalk tool. But even with the GEM being the principle guide, the task of mapping the two coding systems is never simple.
April 16, 2010
ICD 10 - right time to negotiate contracts
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April 5, 2010
ICD 10 – do health plans need I9-I10 crosswalks?
Here’s more on ICD-10 crosswalks! Some payers I’m interacting with are asking if they’d ever need an I9-I10 crosswalk. They acknowledge that they’ll need an I10-I9 crosswalk, if they chose to tactically comply with the ICD-10 regulation, but they’re wondering “why I9-I10”? Some of them believe that if they did start processing I10 codes on October 1st 2013, they’d retain the ability to process I9 based claims. Obviously, not everyone has thought through the cost implications – about maintaining 2 adjudication rulesets (most likely based on “as-of-date” logic), adding complex new rules to an already complex adjudication platform, the cost of “lights-on” of two sets of rulesets etc.
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March 29, 2010
ICD 10 – Effectiveness of Crosswalks
You’ve read about why ICD-9 to ICD-10 crosswalk is going to be needed during the dual processing period! You are probably also aware that any crosswalk will require additional data to be able to zero in on a single ICD-10 code corresponding to an ICD-9 code. So, what is this additional data? Where will you get the data from? Will whatever you are able get, be sufficient for effective crosswalk?
March 22, 2010
So what happens to the payouts and reimbursements when I10 comes around?
As of now CMS is sticking with the concept of clubbing all the corresponding I10 codes for a given I9 code under the same DRG group that was associated with the I9 code. Basically leading to a payment neutral scenario. The large payers also seem to be following the same pattern. But I wonder how long that will last?
Continue reading "So what happens to the payouts and reimbursements when I10 comes around?" »
February 24, 2010
Ever heard of getting caught between a rock and a hard place…
Well, that’s where the provider community finds itself right now. I have been talking to quite a few providers (large and small, specialized and generic) and eventually I have formulated an opinion (You will never find me short of opinions). The hypothesis goes such…
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February 16, 2010
ICD 10 – Crosswalk Strategies
January 29, 2010
ICD 10 – uncertainty around provider reimbursement
CMS has used the opportunity brought in by the increased specificity of ICD-10 codes to increase the granularity of DRG codes. This will help CMS streamline Medicare payments. Since significant number of Medicare and commercial claims is paid based on DRG codes, the added granularity is bound to cause uncertainty around provider reimbursements. This uncertainty combined with the payment reductions under SGR (Sustainable Growth Rate) has the potential to significantly impact providers’ bottom-line. Payers are not immune to the impact either. It’s crucial that payers and providers simulate claim payments, compare the payouts between I9 and I10, and be better prepared for the change.
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December 28, 2009
ICD 10 – processing adjusted claims
The necessity for dual processing with ICD-10 is not just a result of interoperability between entities on disparate code-sets. Even if we assume that all the payers and providers are migrating to ICD-10 (desirable, but hardly a pragmatic situation) on Oct 1st, 2013 (compliance date), dual processing is going to be required for some adjusted claims and inpatient claims.
December 22, 2009
5010 – Are you really ready? – Part 2
Few weeks ago, in one of my blogs, I had attempted to set some basic tenets for the tactical option (downgrade-store-and-forward) for complying with the 5010 mandate. They primarily covered,
• A dynamic rules based bidirectional converter
• A comprehensive store-and-forward mechanism for storing and retrieving reduced data
• A clear performance management strategy to manage data reduction (for down conversion) and data addition (for up conversion)
• A robust API to provide access to reduced data for the downstream applications, and
• A comprehensive test bed and associated test strategy
I promised in that blog that I would not ignore the strategic approach (remediating downstream applications to make full use of the mandate) and would tackle that in a future blog. So here we are. Lets see what are the basic tenets for the strategic approach.
November 20, 2009
HIPAA 5010 transition – building a case for automation
Bad news first… HIPAA 5010 has nearly 1,000 unique changes. Some of these changes (like expansion of patient last name alone) could have thousands of impact points across your applications and databases. Overall, the number of impact points could easily run into a couple hundred thousand for an organization of average size. The direct and indirect impact of these 1,000 changes on the IT systems needs to be analyzed as the first step in the 5010 transition journey.
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ICD 10 – dual processing issue
Provider contracts (among other things) are written using ICD and DRG codes. As a result of the increase in number of codes in ICD-10, a new set of DRG’s will have to be created – to take advantage of the increased granularity of information for payments. Eventually every provider and payer will move to contracts based on ICD-10 and related DRG codes. But the switch will not take place overnight. There will be a transition period, during which contracts will be gradually migrated to ICD-10 world. It is this period that will require dual storage and processing of data.
October 27, 2009
5010 – Are you really ready?
Every place I go these days and ask people the question if they are ready for 5010, the answer that I get is ‘Yes, absolutely’ and then invariably 20 minutes into the conversation it transpires that ‘No, not really’. Most everybody seems to have missed out one or two, and in some cases quite a lot more, crucial components of the overall transition. And it does not matter whether people are opting for tactical (downgrade to 4010 and proceed) or strategic (full remediation) approach.
That made me think; wouldn’t it be a good idea to create an illustrative checklist for things that one must take care of to ensure smooth transition? So, given the fact that once I start thinking on a particular line, I invariably become obsessed about it and must get it out of my system (mostly at the expense of readers), here is an attempt at a very high level checklist for the tactical approach. Will cover the mandatory requirements for the strategic approach in the next blog.
October 22, 2009
ICD 10 – a solid case for business transformation
Business transformation by definition is an initiative to align People, Process and Technology initiatives to the company’s strategy, vision and long term objectives, with defined outcomes such as 30% reduction in operational costs or 70% increase in customer satisfaction.
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September 29, 2009
What is going on with 5010 and ICD10… I guess not much
Not too many organizations seem to be unduly concerned about the impending conversion which is now less than two and a half year away for 5010. Or so it seems at least by the actions being taken in the industry. Though I have been hearing a lot about how worried they are regarding the lack of time they might have for changing such a complex network of application portfolio, but not many seem to be taking actions commiserate with their concerns.
We have seen quite a lot of semi-structured exercises taking place, either using internal staff or leveraging high-end consulting organizations but they are primarily limited to very high level analysis of what is going to be impacted. While the initial high level assessment is not a bad idea at all, in my opinion we should be way past that stage by now. A seventy page power-point deck highlighting the twenty core areas that are going to be impacted would have been a good idea in March’2009 but may not be sufficient in October’2009.
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September 15, 2009
ICD-10 – so what are the ideal timelines?
Is there too less time for ICD-10 transition? Or is there plenty of time? Will my vendor ensure that we’re compliant, or should we engage a consultant to do a thorough gap assessment? These are questions that should be and probably are on every program manager’s mind that’s been entrusted with the ICD-10 implementation in his organization.
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September 11, 2009
HIPAA 5010 – Tactical vs. Strategic Implementation
Cheapest option to compliance – who wouldn’t be interested? Especially in an industry that potentially spends more than a quarter trillion dollars per year on regulations. In the case of HIPAA 5010, developing just the ability to send and receive 5010 transactions will achieve basic compliance and is arguably the cheapest option. I wouldn’t be too hasty to call the organizations that plan for basic compliance as short-sighted, but at the same time I’d recommend that organizations at the very least perform an assessment before heading that path.
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September 9, 2009
Implementing ICD-10: How It Can Help to Reduce Cost and Improve Quality
The implementation of ICD-10 will be daunting to say the least. Estimates regarding what this will take to implement are anywhere from 12,029M – 30,480M; with the bulk of the cost needed for system upgrades, conversion and crosswalks. A simple question to this massive undertaking is what the return will be to the health care industry and likewise for everyone who participates in the health care system.
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August 17, 2009
HIPAA 5010 and business transformation
Enough has been said and written (some in our own blogs here) about how HIPAA 5010 should be seen as “business transformation”. It’s okay to view it as a transformational program as long as you have the extra money and the time to implement one. If you don’t have either or only one of the two, I’d say stay focused on to the compliance aspect and what I like to call the “tactical opportunities” or the low hanging fruit.
July 15, 2009
ICD-10 Coding and Superbill
In the ICD-9 era, the ICD Codes were small in number, though not highly organized as ICD-10 is. Given that the ICD-10 codes bring in the granularity and accuracy to the diagnostic and procedure coding, not to mention decades of familiarity of the coders in ICD-9, how does a provider ensure that these codes are coded correctly?
July 6, 2009
Business Transformation Catalyzed by ICD-10 and HIPAA 5010
As US Healthcare industry races to comply with HIPAA 5010 and ICD10 regulations by Jan’2012 and Oct’2013, these two changes remain as the biggest challenges the US healthcare industry has faced in decades. Processes and IT systems will need to be remediated and people retrained to ensure business continuity and avoid penalties. These two changes are being termed as the “Y2K of the healthcare industry” and are expected to cost the industry close to USD 20 billion for remediation.
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ICD 10 is the Y2K of the healthcare industry – really?
Few industry experts have called ICD 10 “the Y2K of the healthcare industry” and some organizations are taking it too literally – and they couldn’t be more wrong. In my view, the only thing that these two changes have in common is “the extent of their impact on the enterprise landscape”, and the similarity pretty much ends there.
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June 29, 2009
HIPAA 5010 – more than just the pre-requisite for ICD 10!
I wish experts gave HIPAA 5010 the credit it deserves as an independent endeavor to improve EDI and reduce cost of healthcare. Positioning HIPAA 5010 mainly as the “pre-requisite” for ICD 10 is turning organizations’ focus away from implementing 5010 as an improvement measure.
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June 17, 2009
ICD10 transition – Are the providers ready?
Isn’t that the million dollar question? A very wise man once said that for one to be ready to tackle an issue, one first has to acknowledge that there is an issue. Furthermore, one has to consider the issue as a clear and present impact/danger to one’s current state of existence, be it financial, physical or mental.
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June 16, 2009
HIPAA 5010 Transition – is a distinct “pilot” phase necessary?
HIPAA 5010 and ICD 10 are impacting the healthcare industry in an unprecedented way. The scale of the impact to systems and processes is such that there is no scope for debate on the need for upfront risk management strategies. However, I think the need for a distinct pilot phase as part of the risk mitigation strategy is debatable.
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June 5, 2009
ICD-10 – How to deal with the increase in paperwork?
As with anyone, physicians and other healthcare providers see paperwork as more of a burden on them than anything else. While there is no doubt that ICD-10 is going to improve the quality and efficiency of overall healthcare delivery and administration, it is going to increase the burden of paperwork even further. I think there is an urgent need for investment to address providers’ concerns around paperwork, especially with ICD-10 due for implementation in a few years.
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May 22, 2009
ICD10 transition – Potential Healthcare Meltdown? I think not.
So, here we are, in early 2009, worried out of our wits regarding an event that is supposed to take place towards the end of 2013. Any other industry, any other event (with due reverence to the Y2K paranoia) and we would have been calling the alert-raisers as nothing more than rabble-rousers, worse yet, fear mongers. But not with ICD10 transition. No name calling here. In fact the worried lot is definitely in majority this time around.
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