Health Plan Turns to WPC for Help Transitioning to ICD-10

Health Plan Turns to WPC for Help Transitioning to ICD-10

Overview

A regional health plan with a Medicare contract struggled with the implications of ICD-10. The transition was viewed as not just a compliance effort, but as a significant change that could pose a threat to the company’s business. In order to avoid the risks associated with ICD-10, the health plan enlisted WPC’s help to assess the impact and develop a work plan for transitioning to the new code sets.

Business Challenge

ICD-10 poses three primary types of challenges. Financial risk occurs when member benefits, trending models, and provider contracts based on ICD-9 codes are misinterpreted in the ICD-10 environment. Clinical risk occurs when a patient does not get appropriate referral/authorization for access to care or the patient’s care changes inadvertently due to code set changes. Operational risk occurs when workloads increase without appropriate preparation, including staffing levels. The health plan turned to WPC for solutions to the challenges presented in unavoidably transitioning to ICD-10.

WPC Solution

With the proper planning for ICD-10, financial, clinical, and operational impacts can be anticipated and remedied prior to the transition, allowing healthcare organizations to avoid the financial, clinical, and operational risks. WPC’s approach focused on the client’s business and not just the unavoidable change at hand, ensuring success goes beyond just becoming ICD-10 compliant. Success measures include business continuity, accomplishment of business goals in spite of the disruption, and determining and maximizing any benefits that ICD-10 can realistically bring within the client’s unique environment.

WPC provided comprehensive assessment and planning for the health plan, resulting in a detailed inventory of ICD-10 impacts and work items, along with a risk assessment, roadmap, and rough order of magnitude estimate. WPC then worked with key stakeholders to estimate workload and costs, and to determine responsibility, timing, dependencies, and testing requirements for each remediation task across all departments. In addition, WPC performed code equivalency mapping, created comprehensive training and communication plans, as well as plans and checklists for vendors, clearinghouses, delegated entities, and trading partners.

Results

WPC understands healthcare business processes and brings deep expertise and experience with the new ICD-10 standards, focusing on what really matters for a successful migration. For this health plan client, WPC determined the types of code equivalency needed across all business operations and determined translation complexities. WPC provided an impact assessment and developed a work plan that included an overall project plan as well as plans for internal and external communications, training, vendor and trading partner management, and testing. With this information, the health plan now can anticipate the changes ICD-10 will bring and be prepared to address them while reducing risk to its business.

In Their Words

“I would like to thank everyone at WPC for all their efforts to successfully complete the ICD-10 assessment ahead of schedule and under budget. [They are] an extremely professional and knowledgeable group! Their combined expertise was tremendous. We accomplished a lot in a short period of time. The work products delivered are excellent.”

—Managing Consultant, Information Systems Department

To learn more about WPC’s ICD-10 Solutions, click here.



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