Articles, case studies and more


Build an ICD-10 rapid response team for revenue emergencies - October 2015
By Warren Hansen, Associate Director of Provider Consulting, Optum360
Now that ICD-10 is a reality in the U.S. health care environment, providers are finding that October 1, 2015, didn’t bring with it the D-Day scenario they thought it might. But they also know ICD-10-related challenges that aren’t apparent now might manifest themselves in the coming months.

Positive signs in early results - reasons for optimism regarding ICD-10 productivity - September 2015
By Mark Morsch, MS, Vice President of Technology, Optum360
One of the biggest unknowns of the ICD-10 implementation is the effect on coding productivity. Experts have estimated the expected loss in productivity post-ICD-10 as HIM professionals climb the learning curve, and studies of other countries’ post-ICD-10 loss unveil valuable insights.

Payers: How to ensure you have good command of ICD-10 - August 2015
By Carrie Cooper, ScD, MHA
For payers, system remediation, end-to-end testing, financial impact analyses, staff training, and risk analyses/contingency planning should be done. But the real work is just starting.

A saving grace? What the new grace period does and does not mean for ICD-10 unspecified coding - July 2015
By Mark Morsch, MD, Vice President of Technology, Optum360.
With the recent Centers for Medicare and Medicaid Services (CMS) announcement of a ‘grace period’ related to ICD-10 coding specificity for part B physician claims, there is a spotlight on unspecified ICD-10 codes. But how much will HIM leaders need to worry about unspecified codes?

Ten principles to help you engage providers around ICD-10 - June 2015
Optum360’s Tom Darr, MD, chief medical officer, Optum360 Coding Solutions, shares ten principles to help HIM professionals engage physicians.

Make sure your ICD-10 physician training meets the mark - May 2015
Optum’s Deena Kerr, MBA, Director, ICD-10 Education shares here ICD-10 expertise around physician preparation and training for the transition to ICD-10.

Mad dash to ICD-10, Healthcare Finance News
With Oct. 1 on the way, many systems focus on last-minute preparations.

Best Practices in Denial Management - Keeping claims from becoming denials in ICD-10
This guide discusses how denied claims and denial management are current problems that the move to ICD-10 should only exacerbate. Future success means taking a proactive approach to managing denials.

10 facts about ICD-10
To respond to myths and common misperceptions, and to demystify ICD-10, the Centers for Medicare and Medicaid Services (CMS) has identified 10 facts the health care community needs to know.

The ICD-10 delay: What's next for your strategy?
This HFMA Educational Report explores different strategies for moving forward with ICD-10 implementation and making financially prudent choices in preparation for the October 1, 2015, deadline.

The right documentation strategy: improving your clinical and financial performance
This HFMA report examines key issues related to effective clinical documentation improvement, and how to use CDI to support appropriate reimbursement.

ICD-10 frequently asked questions
To help health care providers and payers prepare for ICD-10, Optum™ has answered the most frequently asked questions.

Code theory: the impact of ICD-10 on predictive modeling
The health care industry has been abuzz for some time over the arrival of ICD-10-CM/PCS, the expanded diagnosis and procedure coding system set to replace the current ICD-9-CM code set. The benefits of the new system are widely known: ICD-10 will help fuel better care for patients, inform smarter health care delivery and streamline administrative processes. But what makes ICD-10 a truly exciting advance is something that is considered less often: the impact it will have on the industry’s predictive modeling capabilities.

The DRG shift: a new twist for ICD-10 preparation
Today's health care industry is currently experiencing a defining moment of its own: preparations for the transition to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and Procedure Coding System (ICD-10-PCS). These two code sets — ICD-10-CM replacing ICD-9-CM diagnosis codes and ICD-10-PCS replacing the ICD-9-CM procedure codes — will change the way we assign diagnosis and hospital inpatient procedure codes. Together they are known as the I-10 initiative.

Perspectives: six strategies to improve your health plan's performance in 2012
At Optum, we not only share your passion for health care improvement, we are committedto being part of the solution. This inaugural issue offers industry experts’ thought-provoking discussions — drawn from our recent webinar series — plus real-world examples of proven strategies for improving health plan effectiveness, profitability, and sustainability.

ICD-10 conversion: New tools, strategies are keys to success.
ICD10 Monitor features tools and strategies to help hospital administrators begin preparing their sites for ICD-10.

ICD-10: bring lawyers, guns and money
The conversion to ICD-10 code from ICD-9 code, mandated by the Department of Health and Human Services (HHS), involves a change of seismic proportions. The number of diagnostic codes under ICD-10 will jump to 68,000 from 14,000 under ICD-9, and procedural codes will jump to 72,000 from a relatively meager 4,000. Compliance is critical because these codes are the key to reimbursement.

White papers

KPIs, financial modeling can smooth transition to ICD-10
An integral part of the ICD-10 transition strategy should include key performance indicator (KPI) monitoring and financial modeling that will allow organizations to assess their environment and update or remediate their benefit plans, medical policies, provider contracts and systems as necessary. Read the white paper to learn more.

The benefits of using the independent verification and validation framework
The move from ICD-9 to ICD-10 promises long-term benefits in efficiency and accuracy, but also poses a complex readiness challenge for health care organizations. Across the industry, business partner testing and operational preparedness impact this readiness effort, and are critical to the overall success of the transition to ICD-10. Read the white paper to learn more.

Looking at ICD-10 through a financial lens — what do you see?
Health plans’ full transition to the ICD-10 code sets may be fraught with challenges, but it also could lead to both financial savings and revenue generation if analytics, modeling and projections are used to mitigate risk, improve pricing and enhance financial management practices. Read the white paper to learn more.

Testing: The critical success factor in the transition to ICD-10
This paper highlights the significance of the transformation and transition of the U.S. health system from ICD-9 to ICD-10 by October 1, 2015. It also discusses how proven solutions and strategies can be used to expedite and effectively manage this impactful change.

Selecting the right medical coding partner for ICD-10 and beyond
This white paper examines partnering with outsourced coding services as a strategy for meeting the challenges of ICD-10. It also highlights six attributes a prospective coding partner should demonstrate in order to meet your organization’s needs.

Successfully implementing ICD-10 in your hospital: Don't overlook the physician factor.
Learn why physician training is key to ICD-10 success — and what CFOs need to know to prepare their organizations.

Not all NLP is created equal: CAC technology underpinnings that drive accuracy, experience and overall revenue performance
Critical differences in NLP methodologies affect CAC performance, ROI, and scalability to ICD-10. Learn why LifeCode’s NLP experience matters.

Testing: the critical success factor in the transition to ICD-10
The introduction of ICD-10-CM/PCS will result in a massive overhaul of the IT infrastructure that supports health care coding, billing, and claims management. Health plans will need to modify every system that holds, transmits, or analyzes health data. Payers need a strategy that breaks testing into meaningful components and helps them achieve a successful transition to ICD-10. Testing will allow plans to see where there is work to be done — while there is still time to do that work.

Neutrality risk management in ICD-10 remediation
Neutrality risk management is often thought of strictly in financial terms. With ICD-10, for example, payers will see no impact to their revenue, reimbursement, and medical loss ratio (MLR) after the conversion to ICD-10, and providers will see no loss in reimbursement after the transition. This narrow interpretation of neutrality risk management is not entirely attainable due to the many variables that will affect revenue and reimbursement. The transition from the current code set ICD-9 to ICD-10 has substantial financial and operational implications for the entire health services industry and every aspect of business operations.

Advanced coding technology to advance the revenue cycle
Not all CAC tools are created equal. Understand the key elements of natural language processing and how the precision of the LifeCode NLP technology from Optum can boost coder accuracy and enhance productivity — even amid the transition to ICD-10.

Case studies

ICD-10 collaborative testing to minimize financial repercussions
The transition to ICD-10 affects all functional areas, including medical management, claims, call centers, finance, providers, benefits and enrollment. Health plans need a process that breaks testing in these areas into manageable chunks and helps them achieve a successful transition from ICD-9 to ICD-10. The ICD-10 transition process should revolve around testing that begins early and continues throughout the conversion process.


A complete solution for ICD-10 transition testing

Testing is the determining factor in a successful ICD-10 transition to minimize financial impact and provider abrasion. The Claims Testing Tool from Optum provides complete, accurate, and thorough ICD-10 conversion, reporting, and business intelligence capabilities in a single, comprehensive tool.

ImpactPro for Underwriting demo

Watch a brief online demonstration of ImpactPro for Underwriters.


ICD-10 Education Program: Physician Practice Coder Education
(Specialty-Specific for Ambulatory)

Optum ICD-10 SWAT Assessment
Get on the fast track to ICD-10 readiness with the Optum360TM accelerated readiness plan.

ICD-10 Solution Overview

Optum360TM ICD-10 Readiness Assurance Review
Uncover potential risks now.  Don't pay for them later.


Auditing: Important for ICD-9 but essential for ICD-10
Lisa Walter, vice president of HIM Consulting at Optum360™ discusses why coding quality audits are more important than ever and how to best approach them in an ICD-10 world to continue to ensure compliance. (length 6:23)