Five Crucial First Steps for a Successful ICD-10 Journey

We are quickly approaching the ICD-10 implementation deadline and most payers and providers are still in the planning phase. A recent HIMSS ICD-10/5010 Readiness Survey shows that while providers are making significant progress on ICD-10, it is generally at a slower pace than that for HIPAA 5010.

With less than 30 months left until the compliance date (October 1, 2013), healthcare entities will have to start taking stock, assessing their readiness and taking control of their planning activities.

Because the impacts of ICD-10 are widespread within and beyond individual organizations, it is very important to focus on these crucial first steps before embarking on the exciting journey of ICD10 implementation:

  1. Assessment – Identifying business and IT impacts will help define the scope of resources, effort, and distribution needed to help with remediation
  2. Project Governance – Identifying key stakeholders and establishing the project governance early on will help employees prioritize their responsibilities and focus
  3. Define ROI – Defining Return on Investment (ROI) is crucial for the success of any initiative. Monetary gains, process simplification, and client response and satisfaction are some of the key metrics that help define ROI. ROI is one of the most important aspects of ICD-10 implementation that must be presented to the internal stakeholders. Showcasing the potential ROI from an ICD-10 implementation will ensure executive support and sponsorship of the migration process.
  4. Provider Contracting – Analysis of existing contracts, claim analysis and claim adjudication will provide necessary information and serve as input for ICD-10 financial modeling tools. These modeling solutions will in turn help payers and providers re-negotiate contracts and improve provider satisfaction
  5. Utilization Management – A review of existing ICD-9 Utilization Data will provide inputs to ICD-10 predictive modeling and help payers design programs focused on member health

These are some of the basic steps that need to be taken before ICD-10 implementation activities can be initiated. As outlined in one of our earlier blog posts, it is important that everyone understands the magnitude of the upcoming migration, both in terms of the process and the end results. This will ensure everyone is on the same page and will make for a quicker and smoother transition.

Have you started your ICD-10 Implementation process? What crucial first steps did you take? We’d love to hear your thoughts.

Baskar Mohan

Director - Healthcare Practice, Virtusa. Baskar has more than 18 years of professional IT experience with over 13 years of US project experience. He has worked in the Healthcare industry for the past 11 years both on the payer and the provider systems. He has extensive knowledge of the Blues and has worked with them in many corporate initiatives including the HIPAA 4010A1 conversion, SSNE and the NPI project. On the payer side, Baskar has worked on EDI and core claims systems. During his tenure at BCBSMI, Baskar has worked in EDI, Membership & Billing, Facility, Professional, Dental, FEP & NASCO to name a few. Baskar has also very good exposure to the government run Medicare & Medicaid programs and has worked for the Dept of Health Services, Sacramento, California. He also has executed a number of projects in healthcare related to BPM. Baskar is very knowledgeable of the Pega platform and in specific the Healthcare payer framework, Insurance Industry framework & CPM. More recently he has executed projects related Governance, Risk and Compliance using Pega for providers very specific to CoBIT & HIPAA. As a Chief Architect, Baskar is responsible for designing solutions for 5010 & ICD10 solutions. He has created go to market solutions to help customers transition to 5010 & ICD10. As a Program Manager, he is responsible for delivery & execution of all projects both onsite & offshore and currently manages a team of resources. As a Client Services Director, Baskar is responsible for revenues for healthcare book of business, assist the sales team with pre-sales, account radiation and client management. Baskar has experience working with global clients across, USA, UK, France & Netherlands.

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3 Comments

  • Rasheed April 19, 2011

    Hello Mohan,

    Nice post. When we implemented ICD10 in 2006 the biggest challenge we faced was with “Define ROI”. The ROI was not properly defined and we lost support from the stake holders and senior executives.

    This post will really help the people who are starting ICD10 implementation.

    Thanks,
    Rasheed.

    • Baskar Mohan April 20, 2011

      Rasheed,

      Thanks for the response. ROI definition is critical and it varies by organization. And within the organization the business team might have its own set of ROIs totally different from that of the IT group. So working with all the stakeholders to define ROI is very critical for the success of projects, especially ICD10 where the projects are done purely to comply with mandates.

      Thanks,

      Baskar

  • Shiva Desai December 6, 2011

    Hello Baskar,

    Its a nice post and definitely gives an edge on approach ICD-10 Implementation.

    I found Utilization Management as one of the tough topic than the others. If you can give some more data on Transition effect on Utilization Management, it would be great.

    Thanks,
    Shiva Desai

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