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Are Claims Executives Underestimating ICD-10 Impact?

Despite facing the biggest industry changes in the past 70 years, health care insurance managers and executives are less concerned of the pending policy and compliance changes stemming from the Affordable Care Act and ICD-10 than they are about day-to-day operation metrics, according to a new survey.

Hosted by Enkata, the leader in employee performance optimization, the survey results uncovered surprising insights into the operations and concerns of health care insurance professionals.

Notably, the survey found the impact of these significant changes—the biggest the industry has faced in decades—to take a back seat to daily, run rate concerns such as meeting service level agreements and reducing claims overpayments and underpayments. Additionally, when asked how they were preparing for the change to the new ICD-10 code, an overwhelming 77% of respondents reported they would weather the changes by upgrading technology, with only 5% indicating they would hire new processors (personnel).

"With all of the hype surrounding the impending ICD-10 code adoption and the implementation of the Affordable Care Act, we were surprised that the survey results suggested that health care claims teams were not very concerned about the potential impact of these policies, specifically on their ability to quickly and accurately process claims," says Dan Enthoven, chief marketing officer at Enkata. "These changes promise to deliver a substantial impact on the volume and complexity of claims, and managers need to be ready to respond with the same level of accuracy and efficiency that their customers expect."

"Interestingly, our survey also found health care claims executives plan to rely on new technology investments and upgrades to navigate the changes, without additional personnel support. While IT investments can yield tremendous improvements in support of any new business initiative, the reality is these new changes are going to greatly affect the type and number of claims that their processors will be managing. While they invest in new technologies, health care organizations must consider how to help their existing processors with better training and support to set them up for success in a new and more complicated claims environment," continues Enthoven.   

Additional insights provided by the Enkata Health Insurance Industry Survey include the following:

Manual processing productivity and compliance are the biggest headaches: The survey found a number of issues related to manually entered claims processing that impact organizations. Nearly 50% of respondents selected high variation in processor productivity levels and 45% responded that compliance with processes is among their biggest headaches, indicating strong operations discipline among payers. Forty-one percent of respondents cited budget constraints as the third biggest headache for processors. This is in line with other Enkata data, which show that while claims payers have high quality in general, pockets of errors remain challenging to eliminate.

Managing remote workers a breeze?: Managing remote processors scored very low in terms of what these professionals are troubled by, with only 13% of respondents reporting it as a headache. Enkata's data have consistently shown that a small but impactful set of remote employees have serious performance issues that managers cannot see or address, suggesting that few companies participating in this survey recognize the challenge they face. 

Health care claims are on the rise—and they better be accurate: Expectations that claim volumes will rise substantially in the next two years earned the strongest agreement from survey participants. Additionally, respondents most strongly agreed that they were more concerned about processor accuracy than productivity. With 68% of respondents reporting the approximate cost of manually adjudicating a claim is $5.00 or more, it's no wonder health care insurance executives are focused on accuracy.

Source: Enkata