IBM Sales and DistributionSolution Brief

ICD-10 compliance

Highlights● Develop a plan to support your ICD-10

adoption business strategy

● Create a scorecard for each departmentwith specific, actionable business andtechnical recommendations

● Prepare project plans, timelines, staffingprofiles, implementation timelines andcost estimates

● Build an oversight plan with strategiesfor future updates

The Department of Health and Human Services (HHS) has mandated that all healthcare providers and health plans implement the International Statistical Classification of Diseases and RelatedHealth Problems, 10th Revision (ICD-10) by October 1, 2013. The Centers for Medicare and Medicaid Services estimate that theindustry will spend US$7 billion to comply with ICD-10 requirements.The choice of implementation approach has potential to differentiateyour organization.

Establish an optimal ICD-10 transformationstrategyOrganizations that react to ICD-10 legislation as simply a compliancemandate risk the possibility of unpredictably large costs and small value realization. Alternately, they can choose an innovative strategyand take full advantage of the greater business value offered by ICD-10 codes to offset anticipated costs. The ICD-10 compliancesolution from IBM includes separate but integrated engagements, from strategic planning to final execution of the more tactical initia-tives, to deliver the optimal value for ICD-10 adoption to your business.

Enabling your transformationThe ICD-10 compliance solution is composed of four integratedengagements:

● The ICD-10 strategic assessment which is designed to help plan anICD-10 adoption strategy by evaluating the current state of the business.

● The ICD-10 implementation roadmap begins with plans developedin the strategic assessment to help prepare project plans, timelines,staffing profiles, implementation timelines and cost estimates.

Please Recycle

● ICD-10 business and technical project implementation offerings useIBM’s experience, technical and business process assets and provenservice oriented architecture (SOA) framework to reduce risk, accel-erate delivery and minimize the costs of ICD-10 transformation.

● Our ICD-10 shared oversight and roadmap refresh team engagesIBM senior consultants to jointly share responsibility with you forbuilding a roadmap for future updates, from assessment throughICD-10 business value delivery.

Engagements can be purchased separately or packaged for joint sharingof responsibility with IBM. Organizations that adopt ICD-10 earlierwill be able to better prepare and optimize plans that outline short-and long-term budget requests and the supporting business cases.

Align healthcare initiatives with ICD-10 adoptionThe ICD-10 compliance solution can deliver business, process, peopleand technology improvements. Compliance with ICD-10 offers theopportunity to:

● Establish more accurate underwriting and product offerings.● Base coverage on condition, not only treatment approach, for cover-

age precision.● Spot high dollar conditions sooner.● Gain better understanding of medical conditions by member, group

and population.● Recognize providers that are treating patients with more acute

conditions.● Enhance pay-for-performance initiatives with significantly more pre-

cision in payment by procedure.● Reject fewer claims and establish more precise services approval.● Process fewer fraudulent claims and identifying misdiagnosis

up-coding.

The ICD-10 mandate can be a catalyst to an organization’s transforma-tion plans. IBM’s fundamental concept is to consider the ICD-10 man-date as a potential business opportunity, rather than just anothercompliance project. Our experience tells us that with an incrementalinvestment, sufficient business value can be generated to cover compli-ance cost, as well as deliver a potential return on investment.

For more informationTo learn more about the ICD-10 compliance solution, please contact your IBM representative or IBM Business Partner, or visit:ibm.com/healthcare.

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