ICD 10 Post Implementation

While the ICD 10 conversion will impact all operational areas of the payer’s business cycle, the impact to the area of Risk Management will be measured well beyond the conversion deadline of October 1, 2013.

The core competencies of the payer’s risk management operational area consist of Actuarial, Underwriting and Rating. Fundamental to all three is the capture and analysis of claims experience information.

Also considered in the ana

lysis of experience data are the specific details of the plan design under which the claims experience have been generated, i.e. the plan design, the provisions of the plan as specified in the plan contract.

Challenges faced in the capture and analysis of experience data, have included issues around data quality and data integrity such as:

Limitation in data
Data entry errors
Inconsistent coding

While the specificity of the ICD 10 codes will address the previous limitation in data, and training and education provided in the preparedness of ICD 10 implementation will address and resolve other issues, the value that the codes will add to the historical data requirement of the risk management processes and procedures will not be readily available.

What strategies can be employed in order to address these challenges?

Running both ICD 9 and ICD 10 in tandem for a specified period of time post implementation.
Comparability studies or bridge coding
The use of DRMs (Diagnosis Reimbursement Maps) also called Crosswalks.

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Marina Martin

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