5 Mistakes Payers Should Avoid While Implementing ICD-10

The deadline for ICD-10 implementation is fast approaching and healthcare Payers and Providers have less than two years to meet the requirements. Some healthcare organizations have yet to initiate their plans for the migration, some have progressed at a slow pace and very few have made substantial commitment to completion.

Payers on track with the ICD-10 implementation process should have completed the Risk/Impact assessment of their IT and business areas and started their planning activities. Based on our experience with previous HIPAA implementations, we believe there are a few areas that healthcare organizations need to consider to ensure success of their ICD-10 migration program. Highlighted below are five mistakes Payers should avoid.

  1. Receipt and Processing of ICD-10 codes – While Payers weigh in on the advantages and disadvantages for a partial remediation, more importance should be given to long term strategies. Going in for full remediation allows organizations to reap all the benefits of ICD-10 implementation. It is important to avoid falling into the trap of less risky partial remediation.
  2. ICD-10 Benefits for Customers – Payers should avoid viewing ICD-10 implementation as another healthcare mandate created to increase the cost of healthcare. They should look from the perspective of a member and educate the members on the benefits of ICD-10. This ensures more member retention and satisfied customers.
  3. Implementation Approach – Most CIOs focus on ICD-10 implementation as another IT project and miss out on the key areas of improvement. Considering BPM as an implementation tool will engage businesses more and make them feel part of the implementation success.
  4. Tool Selection – Avoid selecting a tool with inadequate test data capabilities. The tool has to be flexible enough for the business team to use. Remember: the tool will primarily be used by the business and not by IT. This approach will also ensure quick adaption to the tool and avoid frustration associated with quality of the test data.
  5. Test Strategy – More than any other HIPAA implementation, ICD-10 provides a huge challenge for testing. Our experience indicates that the testing aspect of the migration is not given due importance. Test data creation should be of highest priority to ensure coverage of test scenarios. Having a separate vendor specialized in healthcare testing will help the team focus more on the business, rather than technical, goals and objectives.

HIPAA implementations provide us with important insight into the various elements of a successful migration program in the healthcare industry. Above are a few of the traps which Payer organizations should avoid as they progress in their ICD-10 journey. We believe these mistakes, if prevented, can positively impact the timelines, efforts and costs of their migration program. We are curious to hear other challenges and issues you have come across which have critically influenced HIPAA / ICD-10 implementation programs. Please share your comments below.

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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