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

1. Healthcare
Case Study
Medicaid Managed Care Services Company
ICD-10 Financial Neutrality Assessment
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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 reports
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3. The engagement leveraging Infosys’ iTransform™ Payout Simulator delivered the following
key benefits:
Comprehensive and accurate data set analysis using the
1 simulation tool
Ability to determine high risk DRGs and ICD-9 codes based on
2 the historical claims data analysis along with shift patterns
Effective evaluation of various functional scenarios to identify
3 the claims data that influence changes in payout amount
Accuracy in identification of risks across various claims types
4 and means for more effective provider contract renegotiation
Determination of defensive actions based on the data analysis
5 findings to offset prospective financial impact
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4. About Infosys Public Services
Infosys 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 to
transform, innovate and optimize their organizations to build tomorrow’s
enterprise. We blend 30 years of commercial best practices with
innovative industry solutions, best-of-breed partner content and proven
execution 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 change
without notice. Infosys Public Services acknowledges the proprietary rights of the trademarks and product names of other companies mentioned in this document.