State and Federal Agencies: Get ICD-10 Prepared

All providers, payers, and health care entities are compelled to comply with CMS rules regarding ICD-10—that includes state and federal health care programs.

The amount of detail included in ICD-10 will give states the opportunity to better understand and improve health care utilization, cost efficiencies, care management opportunities, and quality of care. By using the improved detailed information, the public sector will be better able to anticipate demand for services and workforce needs and predict costs and future health care trends for their enrolled populations.

Business Issues

State and federal agencies face many unknowns: How will the transition to ICD-10 affect the cost, quality, and outcomes of their beneficiaries? How should they manage the potential disruptions to networks and legacy systems? In an era where budgets are tight, many are anxious about the cost of implementation, and the even greater cost of non-compliance. Start planning now to minimize the potential negative effects.

  • Older “legacy” systems may need adjustments to handle the expanded character sets used in ICD-10
  • Implementation and systems-related costs will require time and resources that must be identified and accounted for
  • State Medicaid Management Information Systems (MMIS) may not integrate with other data systems
  • Public sector systems need to communicate effectively with physician and provider networks, which also must become ICD-10 compliant
  • The new and different code relationships could result in higher volumes of claims being pended or denied

Successful compliance and implementation of ICD-10 will provide the public sector with key elements to improve management of costs, quality of care, identify opportunities to improve health outcomes, address utilization rates, and devise more targeted reimbursement rates.

Partner with Optum

Why should you consider OptumInsight as an ICD-10 partner?

To make a seamless and efficient transition to ICD-10, organizations need to start preparing now. Use our expertise and insight to gain a competitive advantage.

OptumInsight brings unmatched expertise and experience in working with state and federal health care programs including Medicaid, Medicare, TriCare, and others. We currently provide the federal government with critical analytical services to support the delivery of health and human services. Today, one out of every three Medicaid dollars spent in the United States goes through an OptumInsight data system and data from one in four Medicaid recipients' resides in those data systems. Due to our in-depth understanding of the Medicaid program, we are able to provide a comprehensive solution suite for public sector payers and providers.

Our solutions include a wide range of services from gap analyses to ongoing monitoring and compliance and support. We are data experts, therefore, our support services can include greater levels of analytical support, advanced capabilities (e.g. data mining, predictive analytics), and integration and analysis of complex data sources (e.g. unstructured data, health-related data). Technology-agnostic, we can help bring multiple systems together to work within the new ICD-10 coding structure.

Questions to Ask

Critical questions every organization should be asking:

  • Do I trust that vendors of my critical IT systems will be ready by the ICD-10 deadline?
  • Which aspects of the ICD-10 transition should I outsource?
  • Will implementation of ICD-10 jeopardize efficient delivery of quality care?
  • Are my current systems capable of handling the new ICD-10 requirements?
  • Will this affect the costs of care being delivered?
  • How disruptive will this be to my ability to pay claims and provide coverage and care delivery?
  • Will conversion to ICD-10 adversely effect policy directions?
  • Will there be funding available for this federally required change-over? If so, at what levels?
  • Will ICD-10 help improve outcomes and address the needs of special populations?