Weathering the Claims Surge of the ICD-10 Super Storm

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The switch to ICD-10 codes coming in October 2014 is expected to cause significant increases in manual claims processing workloads. Just like a perfect storm, this claims surge from ICD-10 implementation will be driven from a powerful confluence of factors. Sharp increases in coding errors, denials, and adjustments for example. To make matters even worse, productivity is expected to dip as processors and coders work to gain familiarity with the completely new and greatly expanded code set.

When a hurricane approaches, people prepare in advance to minimize damage by boarding up windows and evacuating low laying areas. With the forecasted impact of ICD-10 on manual claims workloads, smart organizations will start preparing now.

When the surge in claims hits, processing organizations must step up their processing capacity in order to avoid longer processing times and associated performance-related penalties. They can do this by adding overtime shifts to their processors’ schedules, which is costly and not necessarily viewed positively by employees. They can expand capacity by hiring new processors, but they have to be trained before they become proficient. Another strategy is to increase the productivity of current staff.

Productivity improvement has many advantages over the other two options. It actually lowers processing costs in the period before ICD-10 comes online, and current processors already have the needed knowledge and expertise. In addition, the benefits of increased productivity will continue to accrue after the ICD-10 claims surge subsides.

Enkata’s employee performance optimization solution reveals where inefficiencies in people and processes exist. Visibility into how claims processors do their work is the key. Something that most payer organizations lack. With this visibility, employers can drive out non-productive employee work habits, identify processor training and skill gaps, and fine-tune inefficient processes. Addressing these basic causes of lost productivity can boost manual claim processing productivity by 10% or more.

Healthcare payer organizations need to have a plan in place for handling the expected claims surge from ICD-10 implementation. Improving productivity now will deliver benefits before, during, and after the storm.