Health Plans: Get ICD-10 Prepared

ICD-10’s expanded specificity and precision holds the potential to reduce costs and improve health outcomes. To implement ICD-10, health plans must use compliant information systems that can accommodate the significant number of structural changes within the ICD-10 code set. Timely testing to confirm the accuracy of claims is imperative as inaccuracies may affect revenue and negatively impact provider relations.

The transition will deeply affect a wide range of health plan systems including claims adjudication, medical necessity processes, reimbursement policy, national coverage decisions, Medicare, Medicaid, and more.

Under ICD-10, a variety of business issues will present themselves. Payers must be prepared to:

Compare historical ICD-9 data to new ICD-10 data for use in provider contracting and value-based purchasing initiatives
Train staff in order to develop new business rules used in claims adjudication, fraud detection, medical management, medical policy, and any claims auditing efforts
Establish provider help lines and allot additional staff to accommodate higher call volumes
Implement appropriate reimbursement mapper for all payment methodologies that currently use ICD-9-CM codes—payers and providers

Partner with Optum

Questions to ask

Why should you consider OptumInsight as an ICD-10 partner?

ICD-10 is a compliance mandate representing a massive advance in scale, scope and complexity over ICD-9, and organizations need to be preparing now.

OptumInsight can help you use the transition to ICD-10 to your greatest advantage.

As the world’s leading provider of medical coding solutions, our solutions are informed by 25 years of experience in coding, payment, and reimbursement methodologies, and we bring a strategic perspective unmatched by other information technology providers.

OptumInsight offers a full suite of comprehensive ICD-10 ready products and consulting services, the only company that can provide a comprehensive solution from start to finish, from now through October 2013. We can help you ensure your organization’s compliance by:

Evaluating your legacy systems and assessing your current applications and interfaces
Providing underwriting/risk assessment and actuarial tools that combine data, analytics, and technology to help you accurately identify risk
Applying strategic techniques that help you assess your business processes, identify gaps, and build and maintain a strong provider network
Conducting online training programs to prepare staff members for the changes
Supplying proven coding and analytic tools, as we do to 70,000 health care organizations and 670,000 individual physicians
Sharing with you our depth and breadth of experience—we can expertly identify the right marriage of products and services for ICD-10 compliance depending on the need

Allowing you to implement, test, and optimize the necessary upgrades with our ICD-10 compatible technology solutions

Critical questions every organization should be asking:

How will my reimbursement process be affected?
Will my auto-adjudication rates remain constant?
Do I trust that vendors of my critical IT systems will be ready by the ICD-10 deadline?
Which aspects of the ICD-10 transition could I outsource?
Do I need to negotiate new provider contracts that include new reimbursement structures?
How can I use this transition to strengthen my provider network?
How will medical policies change under ICD-10?
Who should be the key players as we develop an IT implementation plan?