The U.S. Department of Health and Human Services and CMS provided incentives which will improve the top line reimbursements starting 2012, but to realize this benefit, HEDIS Star Quality Rating System dashboards, business intelligence and supporting data integration and aggregation capabilities will need to be in place. The elimination of data re-keying, manual data entry, and timely access to this information for forecasting purposes will be key.
Health care quality measures will have to be rewritten for ICD-10 coding to identify both the numerator and denominator of measures.
Second, the increased specificity of the ICD-10 codes mean that plans and providers can get and use better information on claims for quality measurement and improvement.
According to CMS, “Invest in Improvement
Health plans should be aware that the 2012 MA reimbursements will be based on the 2011 CMS Five-Star Quality Rating system. Improvement in those areas will increase reimbursement almost immediately. The key is knowing where you are starting, understanding what measures represent the best opportunity for improvement in the Five-Star Quality Rating system, and then focusing resources on making the changes that will lead to the largest improvement in the plan’s overall star rating.”
The ICD-10 Assessment and implementation plan should take this into consideration.