HealthcareCase Study                      Medicaid Managed Care Services Company                      ICD-10 Financial Neu...
Business Situation                                                       By October 1, 2014, healthcare organizations cove...
The engagement leveraging Infosys’ iTransform™ Payout Simulator delivered the followingkey benefits:       Comprehensive a...
About Infosys Public ServicesInfosys Public Services is a U.S. based subsidiary of Infosys (NASDAQ: INFY),a global busines...
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Case Study: ICD 10 financial neutrality assessment for a medicaid managed care company

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Infosys conducted Financial Neutrality Assessment based on ICD-10 by providing various simulations. Download the Case Study to know more.

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Case Study: ICD 10 financial neutrality assessment for a medicaid managed care company

  1. 1. HealthcareCase Study Medicaid Managed Care Services Company ICD-10 Financial Neutrality Assessment www.infosyspublicservices.com
  2. 2. Business Situation By October 1, 2014, healthcare organizations covered by the Health Insurance Portability and Accountability Act (HIPAA) are required to use the International Classification of Diseases - 10 (ICD-10) for all business transactions that contain any diagnosis or procedures The Client information. The transition exercise is a complex process. Realizing success with the ICD-10 transition requires healthcare organizations to adopt a solution that can help them gain business agility, lower the transition risk, reduce cost and effort, and innovate for market differentiation. In the process, all payout/reimbursement schemes based on ICD-9 will be directly impacted One of the largest by ICD-10 implementation. Despite the effort to maintain budget neutrality, changes in payment amounts are inevitable because of the difference in ICD-9 and ICD-10 diagnosis organizations of Medicaid and procedure codes. As a first step the client engaged Infosys to analyze their claims managed care plans and data to ensure that payouts based on the new ICD-10 codes were within reasonable and related businesses in the acceptable variance. Further, the changes to existing payment structures or methodologies were to be proposed on a revenue neutral basis. The client sought to solve the business United States problem of reimbursement payout to determine the payment variance. Infosys Solution Infosys worked with the client to conduct a financial neutrality assessment leveraging Infosys’ iTransform™ Payout Simulator. The objective was to establish a prospective business model enabling process level configuration to achieve financial neutrality along with clinical integrity, cost optimization and operational stability across different functional areas. Infosys successfully demonstrated the application using the client’s claims data. The client chose Infosys to assist in their financial neutrality assessment because of Infosys’ healthcare and relevant domain experience coupled with distinct capabilities of Infosys iTransform™ Payout Simulator product: • A powerful diagnostic tool, with advanced analytics and actionable reporting capabilities around Diagnosis Related Grouping (DRG) and ICD-10 reimbursement variances. • Market ready and could help develop strategies to achieve financial neutrality. Infosys successfully completed the engagement in four weeks providing various simulations to measure the change variable and weightage distribution. The simulations also helped evaluate the impact on payouts and risk coverage in addition to generating DRGs mismatch, dollar variance and other statistical reports. Infosys approach leveraging iTransformTM Payout Simulator included: Data filtering based on the template for analysis to derive statistically significant samples for analysis Infosys Approach Data enrichment by converting ICD-9 to ICD-10 and conversion of ICD-9 DRG to ICD-10 DRG Creation of date models and varied simulation scenarios for analysis Simulating the claims data and measuring the fitment of recommendations, change variable, and weightage distribution Deriving conclusions based on Initial modeling of the claims data and series of simulations and generating actionable reports such as DRG mismatch, dollar variance and other statistical reports2 | Infosys Public Services
  3. 3. The engagement leveraging Infosys’ iTransform™ Payout Simulator delivered the followingkey benefits: Comprehensive and accurate data set analysis using the1 simulation tool Ability to determine high risk DRGs and ICD-9 codes based on2 the historical claims data analysis along with shift patterns Effective evaluation of various functional scenarios to identify3 the claims data that influence changes in payout amount Accuracy in identification of risks across various claims types4 and means for more effective provider contract renegotiation Determination of defensive actions based on the data analysis5 findings to offset prospective financial impact Infosys Public Services | 3
  4. 4. About Infosys Public ServicesInfosys Public Services is a U.S. based subsidiary of Infosys (NASDAQ: INFY),a global business consulting & technology services company.Infosys Public Services helps Healthcare & Public sector clients totransform, innovate and optimize their organizations to build tomorrow’senterprise. We blend 30 years of commercial best practices withinnovative industry solutions, best-of-breed partner content and provenexecution to deliver measurable business value with predictability.For more information, contact askus@infosyspublicservices.com www.infosyspublicservices.com© 2012 Infosys Public Services, Plano, Texas, USA. Infosys Public Services believes the information in this publication is accurate as of its publication date; such information is subject to changewithout notice. Infosys Public Services acknowledges the proprietary rights of the trademarks and product names of other companies mentioned in this document.

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