ICD-10 Risk Management to Deliver Value to Payers and Providers

With only 13 months available to complete the entire ICD-10 life cycle and achieve compliance, payers and providers need to ponder on three critical risk factors:

  • Financial Risk: Payers need to focus on underwriting and reimbursement changes and the overall impact on MLR (Medical Loss Ratio). Providers need to focus on eroding margins and impact on cash flow.
  • Operational Risk: Changes in business processes resulting in loss of productivity and drop in efficiency.
  • Business Risk: If the products are not redesigned to adapt to change in policies, payers risk losing members. Providers also need to plan and take advantage of ICD-10 to improve patient safety and satisfaction; else they would be at the risk of losing patients.

Two other areas that both payers and providers need to focus on are:

  •  Level 2 Testing: While many mistake this for an IT driven activity, during external testing all the stakeholders in the value chain test the end-to-end business processes. Synergy, well-defined business scenarios, rigorous testing process, and qualified people are required for successful level 2 testing.
  •  Value beyond compliance: To release true ROI for implementing ICD-10, both payers and providers need to define and incorporate a plan on how they will benefit from ICD-10. This requires defining 2014 budgets to make investments in care management, clinical documentation, analytical systems, and patient engagement portals.

Syntel, a technology and business process services company with over 14 years of experience in serving the healthcare industry offers nSure10SM, an ICD-10 practice to deliver cost-effective solutions for ICD-10 initiatives.