Payers: How to ensure you have good command of ICD-10

Carrie CooperThe years of preparation, planning and work are about to pay off: ICD-10 is here. On October 1, 2015, the national standardized coding system goes live. For payers, system remediation, end-to-end testing, financial impact analyses, staff training and risk analyses/contingency planning should be done. But the real work is just beginning.

ICD-10 presents a major shift in business for payers. The myriad “doomsday scenarios” can affect all areas of a payer organization. How leadership responds to these issues will mean the difference between knee-jerk reactions and effective business decisions.

With operational readiness in place, it’s time to start monitoring how ICD-10 is affecting payer organizations. You need a team ready to enact contingency plans and consistently review data on key performance indicators (KPIs) set by leadership, including customer service, call volumes, claims lag and staffing.

The hub of ICD-10 monitoring should happen for payers in what I refer to as an Operations Command Center. The Command Center is staffed by individuals who represent all areas of the organization and who have the authority to make decisions in the moment. It would be up to this Command Center team to manage when and how ICD-10 contingencies should be triggered.

Measurable and actionable data is the foundation upon which Command Center team decisions rest. Ideally, a payer will understand the norm around issues like call volumes, wait times and claims lag from past data analyses. Payers can then compare fourth-quarter 2014 data to new data, once ICD-10 is live, to see if issues are truly related to ICD-10 and not some other outlier.

With the Command Center team in place, attention should fall on these areas: customer service, claims and financial trending. As with any potential risk area, payers should regularly evaluate all three to determine if impacts result from ICD-10 or other challenges.

Payers know that issues around ICD-10 will happen, but October 1 is not a date to fear. With KPIs established, the Command Center team can quickly respond to any problem. Critical to the team’s success is having measurable and actionable data provided on a daily basis so proper decisions can be made in the moment by individuals with the authority and knowledge to do so.

ICD-10 will change how payers do business. But with the proper preparations and dedication to proactively and intelligently confronting issues, there’s no reason it can’t be a good change.

Get the KPIs, financial modeling can smooth transition to ICD-10 white paper to learn how KPI monitoring and financial modeling can help you assess your environment and update or remediate your benefit plans, medical policies, provider contracts and systems as necessary in an ICD-10 world. For additional ICD-10 resources, visit the ICD-10 hub.

About the author

Carrie Cooper, associate director at Optum Consulting, earned her Science Doctorate in Health Systems Management and her Master of Health Administration from Tulane University.


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