The migration from ICD-9 to ICD-10 codes is among the most extensive conversion projects healthcare organizations have undertaken. With adoption now set for October 1, 2014, health plans are focusing more than ever on the risks of the transition and how to ensure continuity for all aspects of their business. Because the vast majority of IT systems will be affected, this is no small endeavor.
Achieving financial and operational neutrality, and maintaining provider relationships, medical policy enforcement and care management programs are top priorities for payers. Financial risks have plans concerned. Early pilot testing with external providers has shown unexpected variances in DRG-based payments. In some cases these vary between 10 and 30 percent from projections, representing millions of dollars of risks. Also, many health plans have not kept up with recommended project schedules, especially for testing, and that poses still more uncertainty.
The Edifecs ICD-10 solution is an integrated, end-to-end approach. It helps health plans transition to ICD-10 by highlighting and mitigating risks at each stage of the process. It accelerates timelines to achieve neutrality and business continuity on October 1, 2014 and beyond.