State medicaid bureau successfully implements federally mandated standards for healthcare coding and billing

Client Description

The West Virginia Bureau for Medical Services (BMS) is the designated, single state agency responsible for the administration of the State’s Medicaid program.

Problem/Issue

The federally mandated International Classification of Disease, tenth revision (ICD-10) is a new standard in healthcare coding and billing. The transition from ICD-9 to ICD-10 impacts every Medicaid system, process, and transaction that contains or uses an ICD diagnosis or procedure code and needed to occur before the October 1, 2015.

BerryDunn’s Solution/Approach

The BerryDunn Medicaid project team worked with BMS to plan for a timely ICD-10 transition, dividing the work into four phases:

1. Assessment of communications planning and management; risk planning and management; contingency planning; and Training Business Impact Assessments
2. Remediation of code mapping and updating of related policies
3. Testing and reviewing system test cases and providing system test support, and user acceptance testing (UAT)
4. Providing transition assistance involving provider outreach and contributing to post-implementation analytics and support

Outcomes

With assistance from BerryDunn, BMS met the deadline, secured enhanced funding for the project, developed a webpage to provide information to stakeholders, and performed several assessments to determine the impact of ICD-10 on BMS. A contingency plan was developed to establish procedures for continued operations. All policies were reviewed and updated as necessary. Additionally, BerryDunn coordinated a training plan for the personnel impacted by ICD-10.