Transitioning to ICD-10: How Neutrality Analytics Can Help

Guest post by Vijay Gaware, associate practice manager, MphasiS.

For the healthcare industry, one of the most hard-hitting changes in recent years is ICD-10. One of the most complex regulatory mandates, transitioning to ICD-10 encompasses providers, payers and claims clearing houses. As a result, the transition from ICD-9 to ICD-10 has a far-reaching impact on any organization’s structure, affecting people, processes and technologies.

With October 2014 fast-approaching, healthcare organizations are switching gears and racing to achieve ICD-10 compliance.

Organizations across the board are adopting various measures, such as analyzing the impact, redesigning the architecture, developing the systems, and, finally, testing to ensure ICD-10 compliance.

While some organizations are taking the tactical compliance route by using crosswalk management solutions, others are strategically transforming their systems to capitalize on the opportunities presented by ICD-10. In this crazy scramble for compliance, “neutrality analytics” has emerged as a key game changer that is helping ensure thorough IT and business compliance, while at the same time empowering organizations to reap the benefits of ICD-10.

Neutrality analytics addresses business processes and ensures operations compliance instead of a quick fix approach that is siloed. Without addressing the core business processes, repairing IT systems is akin to mere window dressing that can have large financial and operational implications on an organization. A year ago, neutrality analytics was a grey area. Today, there is greater clarity around what needs to be done and how organizations can accomplish this.

Essentially, neutrality means that there should be absolutely no impact on any of the entities involved in the healthcare business because of ICD-10 transition including members, providers and payers.

Neutrality has four key dimensions: claims payment neutrality, member benefit neutrality, clinical neutrality and operational neutrality.

Organizations that factor in all four neutrality dimensions prior to an IT implementation will sail through the ICD-10 transition smoothly.

Assessment of the above parameters can lead organizations to launch business changes on the business side, such as renegotiating certain provider contracts, redrawing benefit plan structures, reviewing the underwriting guidelines and improving clinical documentation.

Organizations bypassing this assessment and analysis could face turbulent times with a downward spiraling chain of events, including increases in claims rejection, manual prior authorizations, helpdesk call volume,  manual claim re-adjudication percentage and adjudication errors, as well as delayed payments to providers, incorrect payments and dissatisfied providers and members—not to mention  management’s time and the organization’s reputation.

With so much on the line, factoring in neutrality analytics in overall ICD-10 strategy is extremely critical to deriving business value from ICD-10 compliance and providing greater assurance to stakeholders.

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