paradigmImagine increasing the identification and classification of diseases from 14,000 to 70,000.  Another component of the new ICD10 (International Classification of Diseases) system is that there will be a separate set of procedure codes for hospitals increasing from 4,000 to 72,000.  Big data is going to get bigger for insurance claims involving medical services and treatments.

Originally developed by the World Health Organization (WHO), the ICD10 system was created to record diseases and injuries in a standardized and uniform format. Federal agencies further developed an enhanced version for the United States. ICD10 was originally scheduled for deployment in 2011, but with delays and other political issues, it did not happen until now. For the last three years, hospitals and physicians groups have spent billions of dollars to get ready for the transformation (training programs, apps, practice drills, etc.).

The new ICD10 system will provide some better capabilities for our healthcare professionals and research scientists.  For example, physicians will be able to properly code a diagnosis of specific injuries and diseases and not have to use a generic “all purpose” code. There will be several advantages for the insurance and risk management professions, too.

The basic and first step in reviewing medical codes and procedures is to validate them, and ensure that code and procedure match.  That’s easy!  But how will you receive, analyze, and make the right decisions on claims with 72,000 new codes and procedure?  If you are not utilizing an advanced analytics platform in your business process, you are going to lose this race.

Healthcare costs are continuing to increase.  The fraud embedded deep in the systems can be identified and mitigated with the right advanced analytics solutions.

Is your claims team ready for this paradigm shift?