Case

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www.infosyspublicservices.com

Healthcare

Medicaid Managed Care Services CompanyICD-10 Financial Neutrality Assessment

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Data filtering based on the template for analysis to derive statistically significant samples for analysis

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

Business SituationBy 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 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 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 and procedure codes. As a first step the client engaged Infosys to analyze their claims data to ensure that payouts based on the new ICD-10 codes were within reasonable and 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 problem of reimbursement payout to determine the payment variance.

Infosys SolutionInfosys 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.

The Client

One of the largest

organizations of Medicaid

managed care plans and

related businesses in the

United States

Infosys approach leveraging iTransformTM Payout Simulator included:

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1 Comprehensive and accurate data set analysis using the simulation tool

3 Effective evaluation of various functional scenarios to identify the claims data that influence changes in payout amount

2 Ability to determine high risk DRGs and ICD-9 codes based on the historical claims data analysis along with shift patterns

4 Accuracy in identification of risks across various claims types and means for more effective provider contract renegotiation

5 Determination of defensive actions based on the data analysis findings to offset prospective financial impact

The engagement leveraging Infosys’ iTransform™ Payout Simulator delivered the following key benefits:

For more information, contact askus@infosyspublicservices.com www.infosyspublicservices.com

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.

© 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.