Medical Billing Consultancy Role in Practices Planning for ICD-10 Conversion

The extent and scope of ICD-10’s clinical and operational impact is such that it is going to influence how functional departments coordinate and operate internally among themselves as well as with external entities such as payers and regulatory bodies. Therefore, it is imperative that providers migrate to clinical and operational practices that best endorse ICD-10 requirement. Hence practices are increasingly realizing the need to spruce up and better integrate the three important components: people, technology, and processes. While they may have the will and financial might to pay for elevating these three factors, they may still lack the requisite foresight and planning, which are the pre-requisites to a successful ICD-10 implementation. This is where, the external consultants – with a track record of delivering HIPAA 5010 and ICD-10 assessments, ICD-10 impact analysis, and ICD-10 implementation plans on time and on budget with excellent results – assume significance.

Having realized the importance of partnering with external consultants, practices have one more thing to evaluate: the process adopted by their prospective consultants. Ideally, the best consulting should comprise of:

  • Business roadmap development
    As part of the comprehensive consulting plan, practices should insist on drawing a business roadmap development from their consultants. Such a business roadmap development need necessarily be backed by your desire to achieving organizational change. Further, it should pave way for forming a guiding coalition that can firm up the change vision, develop a roadmap of change initiatives and organize the teams of people responsible for getting the work done.
  • Training
    A business roadmap development will never see the day of light unless and until it is backed by action in terms of training. Therefore, your prospective consultants training should necessarily involve key information about the ICD-10 code set, how to use it, how to benefit from it, and what the implementation steps are to be followed.
  • High level review
    Early assessment helps you gain a strong understanding of how ICD-10 will impact your organization. Therefore, your consultants should focus on people, business processes and technology to assess the impact of ICD-10. It is a critical part of any ICD-10 initiative since ICD-10 has the potential to impact so much of your business, including programs and systems for claims, analytics fraud detection, enrollment, eligibility, benefits, pricing, sponsor contracting, medical management, provider electronic data interchange (EDI) transactions and other areas.
  • In-depth assessment & gap analysis
    The success of ICD-10 consulting depends on how best consultants make an in-depth assessment and gap analysis of their clients’ (physician practices) clinical and operational practices vis-à-vis ICD-10 and HIPAA 5010 standards. An in-depth analysis of complex artifacts may include a review of underlying HIPAA 5010 EDI transactions, and ICD-10, trading partner coordination & testing plan review, and as–is & to–be process review. Such analysis is indispensable in measuring the extent of migration required to comply by ICD-10 and HIPAA 5010.
  • Implementation planning and design
    Once your consultant establishes that extent of migration to be pursued, the next phase should involve pooling resources (strategic direction, high level review) to develop the detailed design. The design should necessarily focus on business processes that require modification and IT applications that require remediation and replacement.
  • Implementation and ICD-10 compliance
    The final step in the ICD-10 conversion, the implementation and ICD-10 compliance should help physician practices achieve ICD-10 compliance and realize efficiencies while mitigating risk. During this phase, consultants should make necessary modifications to implementation plans based on recommendations from the planning and design phase.

As ICD-10 and HIPAA 5010 compliance is going impact on core clinical and operational functions, including patient care, drug administration, provider systems and reporting,  – by virtue of competent understanding of the people and process changes needed to support ICD-10 implementations – can easily enable providers to evaluate the technical impact of the change and determine the best way to meet those changes.