The significant increase in code classifications will affect how departments function within themselves, with each other and with outside organizations. As payers take the time to become educated about ICD-10 and 5010, it becomes clear that the impacts are not contained within one area of the business, such as claims.
In fact, there are broad reaching, unavoidable requirements that will impact how payers operate moving forward. A workflow analysis to identify potential gaps in process, and redesign of workflows and product configurations to accommodate those changes is critical to preparing for ICD-10 implementation and transaction and code transitions and configurations that result in claims being denied or billed under both coding systems. Consider the effects that ICD-10 will have on Explanation of Benefits (EOB) statements.
This seemingly simple piece of the puzzle has far-reaching impacts across people, process and technology. The provider will need to give the proper codes. The payer will need to accept those codes to determine payment and issue an EOB. Members need to receive communications that educate them about new information appearing on their EOBs. And customer service representatives need training and preparation to intelligently answer members. Many organizations skip this analysis stage and go right to implementation. Spend time to assess the impact of the codes
Disconnected process can lead to missed requirements, workflows that don’t work and missed deadlines
With a strong understanding of the people and process changes needed to support ICD-10, payers can next evaluate the technical impact of the change and determine the best way to meet those changes. As we and our clients are learning, changes in technology required by ICD-10 and 5010 compliance will affect all core areas of payer operations, including patient care, pharmacy, provider systems and reporting.
For more information on ICD-10 Assesments & Consulting, visit www.noworldborders.com/icd-10.html