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a2c Consultant Implements an Innovative Solution to a Potentially Costly Program 10/31/2013 Katherine Markham provides 40% in savings by incorporating an adaptable, scalable, stand-alone Healthcare Transformation Framework into an existing systems . . .

 

Response to government mandated use of International Classification of Disease 10 (ICD-10) codes has resulted in costly business process and systems modifications to ensure compliance by all Health Insurance Portability and Accountability Act (HIPAA) covered entities. Faced with the challenge of meeting these mandates, a2c Consultant and Program Manager Katherine Markham successfully brought an innovative solution to a potentially costly program to fruition this past month. The veteran consultant was able to place the Blue Cross Blue Shield (BCBS) healthcare insurer “far ahead of the curve” prior to the October 1, 2014 implementation date for the code transition. In revising the scope of the ICD-10 program, a2c consultant Markham was able to provide 40% in realized cost savings by incorporating an adaptable, scalable, stand-alone Healthcare Transformation Framework into the company’s existing systems.

 

The BCBS healthcare insurer is currently overhauling their processing structure and “sunsetting” many of their existing systems. Simultaneously the entire healthcare industry must

comply with federal mandates that require full implementation of the new ICD-10 codes. The original a2c scope of work for this program proposed conversion of over 300 existing systems to accommodate the new codes. Execution would have necessitated transitioning the entire structure from the current ICD-9 codes to the corresponding 225,000 ICD-10 and Procedure Classification System Codes; a transition that constitutes over a 500% total increase. The effort would become redundant once the upgraded system is in place, resulting in an extensive and undesirable expenditure of resource.

 

The insurer requested that Kevin O’Donoghue, a2c Managing Director of Relationships & Business Development, and National Account Manager for BCBS, provide the right talent to execute this program.  Mr. O’Donoghue and a2c engaged their National Healthcare Practice Leader, Katherine Markham and her team to take on this challenge as Program Manager.  Ms. Markham has accumulated over 24 years of expertise in interpretive analysis and implementation of compliance systems which adhere to governing mandates including those issued by

HIPAA, Medicare, and Centers for Medicare and Medicaid Services.  Her proficiency in her field is widely acknowledged; she has co-authored professional articles and books on provider and payer collaboration, and a whitepaper specifically addressing her recommended “Approach to ICD-10 & ANSI v5010 Legislation.”  Katherine Markham reviewed the ICD-10 program and saw opportunities that would eventually culminate in over $5m in realized cost savings. The a2c Program Manager along with a2c Project Manager Carla Atkinson and the insurer’s Healthcare Reform Team collaborated to develop and implement a creative and cost-effective solution.  With Markham’s assistance, the number of systems requiring modification to accommodate the new codes was reduced from over 300 to only 21, resulting in a significant decrease in monetary outlay. 

 

Though challenging, the ICD-9 to ICD-10 conversion is necessary, explains Ms. Markham.  ICD-9 was originally implemented in the late 1970’s; technological advances in medical diagnosis and procedures have rendered the old classifications obsolete.  Eventually these modifications will be beneficial to all healthcare organizations, allowing more specific diagnoses, and consequently fewer claim rejections and denials.  The conversion will also allow for more thorough analysis of accurate diagnosis and procedural/treatment effectiveness as accumulated data is fed through the Healthcare Effectiveness Data Information Set (HEDIS).

 

For this BCBS insurer, the new system is being designed concurrently with the ICD-10 codes fully integrated while the Healthcare Transformation Framework enables the existing system to perform “business as usual,” effectively meeting all federal mandates and eliminating the need to fully revise the existent structure.  Without Markham’s intervention and assistance, the mandated transition would have been cumbersome, difficult to implement, and 60% “throw-away.;

 

This unique and versatile solution is not limited to ICD-9/ICD-10 conversion efforts, but has application in a variety of coding compliance programs in virtually any industry vertical where mandates require significant and costly system overhauls; Markham and the a2c team designed the Healthcare Transformation Framework to be a scalable, turn-key and adaptable solution.  In an industry such as healthcare, code revisions are a constant; even now conversion mandates from CPT-4 (Current Procedural Terminology-4) to CPT-5 are pending.  In the ICD-9 to ICD-10 scenario, the required ICD-10 codes enter the system from the healthcare providers and are fed to the self-contained Healthcare Transformation Framework where they are transformed for claims processing, allowing the insurer to conduct their business in the customary manner. The claim is fed back through the Healthcare Transformation Framework, and payment is issued under the original ICD-10 code, allowing providers to sustain an uninterrupted stream of revenue while maintaining full compliance, and reducing mandated time constraints.

 

The Healthcare Transformation Framework provides a precipitous solution which achieves compliance in a cost-effective manner.  The Healthcare Transformation Framework will permit access by business partners, physicians, payer institutions, and third-party vendors, all of whom have the capacity to utilize and share in the cost of this product.   “This is the first time that a compliance initiative has the potential for revenue implication” for the initiating organization, and return on investment, explained Katherine Markham.  “It enables business partners who are behind the curve to leap into compliance, and is particularly effective for those who are involved in mergers, acquisitions, or are in a fluctuating environment” and need to become compliant quickly.  The Healthcare Transformation Framework will provide capacity for those affiliates to meet that October 1st target date without losing their revenue stream, she said.

 

The Healthcare Transformation Framework can be rapidly deployed into any existing system, allowing the concerned entity to continue to “do business as usual” and to quickly meet mandated regulations.  If integrated into an existing system now, the Healthcare Transformation Framework allows ample time for full compliance with HIPAA ICD-10 mandates prior to Oct. 1, 2014, concluded a2c consultant and Program Manager Katherine Markham.

 

For further information on the a2c Healthcare Transformation Framework contact:

John DiPietro, CTO at jdipietro@a2c.com or

Kevin P. O’Donoghue, National Manager, BCBS at kevinod@a2c.com