Edifecs Aims to Remove the Financial Risks from ICD-10 Transitions

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New Software Updates Reveal the Code Shifts that Pose the Greatest Threats to Financial Neutrality

Today, at the Healthcare Financial Management Association National Institute, Edifecs, Inc. released the next versions of Edifecs ICD-10 Impact Analytics and Edifecs ICD-10 Code Management. These software solutions enable healthcare organizations to make the federally-mandated transition to the new diagnostic code sets without negatively impacting their operations or bottom lines.

The transition to ICD-10 is expected to impact nearly every business process within a healthcare provider organization, including scheduling, referrals, clinical documentation and coding, submission of claims, and reports. As provider organizations are preparing for the transition, it is critical that they are able to map ICD-9 codes they currently use to ICD-10 alternatives. Crosswalks and maps are code relationships that can help identify areas of greatest risk, which can be used to effectively prioritize remediation activities. Further, code crosswalks and maps may also help adaptation of business processes, systems and reporting for the ICD-10 transition.

Edifecs ICD-10 Impact Analytics and Edifecs ICD-10 Code Management solutions reduce operational and financial risk through self-service tools that quickly identify revenue variances and code shifts with the highest complexity. By focusing remediation resources on the areas of greatest risk, healthcare organizations can address the equally critical challenges of reducing costs and mitigating risks of the ICD-10 transition.

“We understand that ICD-10 is a highly burdensome mandate placing strains on the healthcare industry – with the business implications as a top concern. These solution enhancements will enable our healthcare provider partners to target necessary remediation actions by gaining insight into high risk ICD-9 and ICD-10 code shifts,” said Deepak Sadagopan, general manager of clinical solutions and provider sector at Edifecs. “They eliminate financial uncertainty and allow providers to take precautionary measures to assure continuity of expected revenue after the transition.”

Greater Level of Detail into the Financial Impact to the Business
One of the biggest ICD-10 transition challenges for provider organizations will be quantifying the likelihood that a facility, specialty, or whole enterprise is likely to lose or gain revenue. Edifecs ICD-10 Impact Analytics utilizes standard and custom maps and crosswalks to model all possible ICD-9 to ICD-10 mappings and pinpoints those that pose the greatest risks at different levels of the organization, and with each payer contract. This deeper level insight into the root causes of revenue variance identifies remediation actions that should be taken in order to minimize or eliminate them altogether.

Once provider organizations have identified revenue variances that pose the greatest risk to the business’ top line, collaboration with trading partners will be necessary to ensure that the goals of financial neutrality are addressed. For example, providers can undertake collaborative testing with their key trading partners. Collaborative testing reduces additional operational and financial risks by quickly and consistently comparing large volumes of test results between ICD-9 and ICD-10 data, helping organizations maintain optimal business outputs through the transition.

Significant Operational Impacts
Edifecs ICD-10 Impact Analytics and Edifecs ICD-10 Code Management identify specific operational costs needed to code an episode of care – termed by Edifecs as “Cost of Coding” – including reviews, updates and billing amounts for a code. Coding costs will be greatly impacted as a result of the ICD-10 transition, and the software updates to Edifecs ICD-10 Impact Analytics and Edifecs ICD-10 Code Management will help providers identify codes that fall at the intersection of high complexity, high dollar value and high volume. The software updates also equip providers with knowledge of the type of specificity required in clinical documentation for each medical specialty or service line. This information can also be used to develop targeted training programs for clinicians and ICD-10 coders within the provider organization.

Large organizations require a technology solution that facilitates collaborative development and management of code crosswalks across several work streams. The new releases of Edifecs ICD-10 Impact Analytics and Edifecs ICD-10 Code Management will use enterprise-wide crosswalk management capabilities to publish, share and compare ICD-9 and ICD-10 crosswalks, and enable the enterprise to retain oversight and track progress across facilities.

About the ICD-10 Transition
ICD-10 is the tenth revision to a coding system comprising tens of thousands of codes—each defining a particular health condition—that healthcare organizations use in myriad business and clinical processes. This revision adds more than one hundred thousand increasingly detailed codes, which provide meaningful information about health conditions and surgical procedures for analysis and reporting.

Against a backdrop of skyrocketing costs, unforeseen risk and unprecedented levels of integration required to comply with the federally-mandated transition to ICD-10, there is also an opportunity. Using the increased granularity of information afforded by ICD-10, providers and health insurers alike can enhance administrative performance, improve how they measure the quality of care, provide better data for more precise reimbursement and clinical studies, and improve overall healthcare performance. Recently, the Department of Health and Human Services issued a formal proposal to delay the ICD-10 compliance deadline by one year, which would delay the deadline, previously slated for October 1, 2013, to October 1, 2014.

Edifecs ICD-10 Impact Analytics and Edifecs ICD-10 Code Management are two of four products comprising the overall Edifecs ICD-10 Solution—an end-to-end solution specifically designed to support each phase of an ICD-10 project. Healthcare organizations have the choice of deploying each product independently or using them together as an integrated suite.

The need for more effective and insightful ICD-10 transition solutions is particularly important, as it is one of the largest and most far-reaching initiatives undertaken by the industry in 30 years. Unlike previous mandates that were more technology and format-focused, ICD-10 will affect nearly every aspect of a healthcare organization’s business, including pricing, claim management and payment processing.

About Edifecs, Inc.
An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA 5010 and ICD-10.

Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.

Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of Washington, 100 Best Places to Work in the state of Washington, an Inc. 5000 fastest-growing private company and one of the500 Fastest Growing Companies in North America by Deloitte. Edifecs is headquartered in Bellevue, WA. For more information, please visit http://www.edifecs.com.

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