Reduce Operational Costs to Alleviate the Burden of Economy & Health Care Reform

Continuing economic pressures and recently enacted Health Care Reform mandates place additional pressure on all health plans and managed care/payers to improve their operational efficiencies and reduce associated costs. Future reductions in Medicare reimbursement rates and increased competition will also require everyone to “do more with less money.”  Industry mandated changes for HIPAA X12 5010 transactions and ICD-10 Diagnosis codes will also add to these efficiency pressures and stretch current limited project staff resources even more.

The new ICD-10 code changes will have a direct and significant financial business impact on revenues on health plans, payer organizations and health care providers. The ICD-10 code set change is not just another new IT project. The ICD-10 changes are much more than simple cross references from the old ICD-9 codes to the new ICD-10 codes. In fact, these types of simple cross walks will simply not work. For many of the new ICD-10 codes, there is a “one to many” code range from the old codes to the new codes. There will also be a significant internal staff retraining effort required with this new code set. This will not be accomplished by simply providing all staff members with a simple cross reference list. For example, some of the areas that will be directly impacted are: provider contracts, benefits plans, performance related reporting (both internal and external), and all related risk severity adjustments to name a few.

Now is the time to start educating and preparing each organization’s key stake holders on the specific changes required in implementing the new ICD-10 code sets, the required resources to implement them, and the required budget allocations to effectively accomplish the new mandated changes. ICD-10 codes must be implemented in the next couple of years. They are not going away!

Every week, we hear from current and prospective clients who are looking for new software technologies and services solutions that will provide the needed efficiency improvements and cost reductions that are so critically needed and sought after. Several of HCIM’s solutions do in fact already provide these types of efficiency gains and immediate Return on Investment (ROI). Many of these related client testimonials are provided in HCIM’s website, newsletters, and solutions fact sheets. I would encourage those who are seeking these types of immediate result-orientated solutions to browse our website and associated content. Several of our clients are already achieving these critical improvements and cost reductions.

In my upcoming blog postings, I will talk more about our expanding efforts to provide educational and training opportunities related to the new ICD-10 code sets. Stay tuned for more information.

About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.