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ARTICLES
ICD-10 Frequently asked questions 
To help health care providers and payers prepare for ICD-10, Optum has prepared the answers tofrequently asked questions.
Code Theory: The Impact of ICD-10 on Predictive Modeling
The healthcare industry has been abuzz for some time over the arrival of ICD-10-CM/PCS, the expanded diagnosis and procedure coding system that is set to replace the current ICD-9-CM code set. The benefits of the new system are widely known: ICD-10 will help fuel better care for patients, inform smarter healthcare delivery and streamline administrative processes. But what makes ICD-10 a truly exciting advance is something that is considered less often: the impact it will have on the industry’s predictive modeling capabilities.
The DRG Shift: A New Twist for ICD-10 Preparation
Today's healthcare industry is currently experiencing a defining moment of its own: preparations for the transition to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD–10–CM) and Procedure Coding System (ICD–10–PCS). These two code sets—ICD-10-CM replacing ICD-9-CM diagnosis codes and ICD-10-PCS replacing the ICD-9-CM procedure codes—will change the way we assign diagnosis and hospital inpatient procedure codes. Together they are known as the I-10 initiative.
Perspectives: Six strategies to improve your health plan's performance in 2012
At Optum, we not only share your passion for health care improvement, we are committedto being part of the solution. This inaugural issue offers industry experts’ thought-provoking discussions—drawn from our recent webinar series—plus real-world examples of proven strategies for improving health plan effectiveness, profitability, and sustainability.
A Top Five for ICD-10
ICD-10 is on the short list of things keeping hospital executives need to worry about. From 17,000 codes under ICD-9 to 155,000 under the new regulation, ICD-10 takes coding and reimbursement to a whole new level – and will exponentially impact the financial health of every hospital. Mark Morsch, vice president of technology for OptumInsight describes what every provider needs to know as they prepare for the transition.
Innovations—Artificial intelligence technology holds the key to improving claims coding productivity, preparing for ICD-10
With ICD-10, coders need to get to a high level of granularity in clinical documentation for hospitals to be reimbursed properly. Since implementing OptumInsight’s Computer-Assisted Coding system, Ohio Health has seen diagnostic coder productivity increase 105.6 percent over the average productivity standard and emergency department coding productivity increase 60 percent since January—a 91.7 percent increase over the current average productivity standard—while maintaining high rates of accuracy and compliance. At the same time, Ohio Health realized more than $300,000 in annual cost savings in the coding department as the use of CAC allowed the re-allocation of six full-time coding positions.
Calling All CFOs – ICD-10 is a NOW issue
Ron Jones, senior vice president of hospital solutions, who works closely with CFOs at a number of the nation’s leading hospital and health systems, is shocked to hear that ICD-10 is not on every CFO’s short list of issues to address. In this blog post, he describes how ICD-10 is a revenue/reimbursement issue — not just an education or coding issue — with potential financial impacts from lost productivity, denied claims and undercoding, which require hospitals and their CFOs to prepare today.
ICD-10 Conversion: New Tools, Strategies are Keys to Success
ICD10 Monitor features tools and strategies to help hospital administrators begin preparing their sites for ICD-10.
ICD-10: Bring lawyers, guns and money
When the deadline for healthcare organizations to comply with the International Classification of Diseases version 10, aka ICD-10, arrives on Oct. 1, 2013, there will be wailing and gnashing of teeth—unless you’re doing that already. In that case, you should be fine.
Kidding aside, the conversion to ICD-10 code from ICD-9 code, mandated by the Department of Health and Human Services (HHS) in a final rule promulgated exactly two years ago, involves a change of seismic proportions: The number of diagnostic codes under ICD-10 will jump to 68,000 from 14,000 under ICD-9; Procedural codes will jump to 72,000 from a relatively meager 4,000. Consider Y2K a warm-up in comparison.
This one will hurt if you do not comply because these codes are the key to reimbursement. Failure, as NASA says, is not an option.
Top Technology Innovations 2009 Ingenix EDI Solutions
Link to external article on Health Data Management web site
WHITEPAPERS
Testing: The Critical Success Factor in the Transition to ICD-10
The introduction of ICD-10-CM/PCS will result in a massive overhaul of the IT infrastructure that supports health care coding, billing, and claims management. Health plans will need to modify every system that holds, transmits, or analyzes health data. Payers need a strategy that breaks testing into meaningful components and helps them achieve a successful transition to ICD-10. Testing will allow plans to see where there is work to be done — while there is still time to do that work.
Neutrality risk management in ICD-10 remediation
Neutrality risk management is often thought of strictly in financial terms. With ICD-10 for example, payers will see no impact to their revenue, reimbursement, and medical loss ratio (MLR) after the conversion to ICD-10 and providers will see no loss in reimbursement after the transition. This narrow interpretation of neutrality risk management is not entirely attainable due to the many variables that will affect revenue and reimbursement. The transition from the current code set ICD-9 to ICD-10 has substantial financial and operational implications for the entire health services industry and every aspect of business operations.
Advanced Coding Technology to Advance the Revenue Cycle
Not all CAC tools are created equal. Understand the key elements of natural language processing and how the precision of Optum’s LifeCode NLP technology can boost coder accuracy and enhance productivity—even amid the transition to ICD-10.
Preparing for ICD-10: Evaluating Approaches and Potential Pitfalls
The health care industry breathed a figurative sigh of relief when the Department of Health and Human Services (HHS) extended its ICD-10 implementation deadline by two years, from October 1, 2011 to October 1, 2013. The extension provides organizations with additional time to prepare for the transition and to assess how the use of the new code set will affect them.
Will Opportunities be Leveraged or Squandered? Why Organizations Should Approach 5010, ICD-10 and HITECH Act Compliance with a Single Strategy
Will the health care industry squander the opportunities that lay ahead? The industry’s history is littered with squandered opportunities, particularly when those opportunities come through legislation and regulation. Why should anyone expect new opportunities to result in different outcomes?
CASE STUDY
Achieving ICD-10 Financial Neutrality—fact or fiction?
The Oct. 1, 2013 deadline for implementation of the ICD-10code set is rapidly approaching. As organizations prepare, manyare wondering if the switch to ICD-10 will be fi nancially neutral.In essence, will payments under ICD-10 be similar to ICD-9?
ICD-10 Collaborative Testing to Minimize Financial Repercussions
The transition to ICD-10 has an impact across all functional areas, including medical management, claims, call centers, finance, providers, benefits and enrollment. Health plans need a process that breaks testing in these areas into manageable chunks and helps them achieve a successful transition from ICD-9 to ICD-10. The ICD-10 transition process should revolve around testing that begins early and continues throughout the conversion process.
In this Window of Opportunity, What's Your Affiliate Strategy?
A unique window of opportunity exists for large hospital systems and integrated delivery networks to sharetheir Electronic Health Record (EHR) systems with their affiliated independent physician practices. Combining the current availability of stimulus funds with a relaxed regulatory environment related to the Stark law makes this the right time to develop an EHR affiliate physician engagement strategy to examine the level of effort and cost of such a program.
Indian Stream Health Center Reduces AR Days
With Ingenix EncoderPro Expert, Indian Stream Health reduced its AR days from 82 to 45 in less than three months.
Demos
A complete solution for ICD-10 transition testing
Testing is the determining factor in a successful ICD-10 transition to minimize financial impact and provider abrasion. Optum’s Claims Testing Tool provides complete, accurate, and thorough ICD-10 conversion, reporting, and business intelligence capabilities in a single, comprehensive tool.
ImpactPro for Underwriting Demo
Watch a brief online demonstration of ImpactPro for Underwriters.
Videos
Transforming CDI with NLP Technology
Optum and UPMC have automated CDI with impressive results, including millions in additional revenue. Watch video.
ICD-10 Testing: The Critical Success Factor for a Successful ICD-10 Transition
CMS has announced the October 1, 2014 ICD-10 compliance date. Health plans should take advantage of the extra time and start ICD-10 testing today to ensure a successful transition – and avoid external discontent (providers, states, CMS, members), risk of non-compliance, internal rework and increased costs.
ICD-10: Big Changes Bring Big Opportunities
ICD-10: Big Changes Bring Big Opportunities. Watch video.