ICD-10: Assessing Financial Risk
Can health insurance plans map their way to financial neutrality?
The industry is asking if ICD-10 will be a financially neutral conversion. This is not an easy question to answer. The proposed rule to move the ICD-10 compliance date to October 1, 2014, will not make it any easier to answer, but it will provide the industry with more time to prepare and identify potential risk. Regardless of the date, the facts remain: The ICD-10 code structure is significantly different from ICD-9, and the transition is expected to impact many health care clinical, business, and technical functions.
It may be challenging for health plans to identify their ICD-10 financial risk because they have no ICD-10 coding and claims experience. Currently, there are limited options to assess potential risk. Deloitte conducted financial risk assessments with two statistically significant data sets to evaluate ICD-10 financial risk and to evaluate the hypoth¬esis that a health plan can map its way out of financial risk. Our assessments determined that mapping ICD-9 to ICD-10 will not drive to financial neutrality on the MS-DRG reimbursement methodology.
Even so, piloting ICD-10 transactions before the compliance deadline could help reduce risk of disruption to revenue, reimbursement, and operations and may result in a more seamless transition across the industry.
Read more about the assessments and smart first steps health plans can take to prepare.
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