Health Language Blog

The Emerging Role of Clinical Terminology Management for Payers

Posted on 05/03/13

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With the internal transition to ICD-10 well underway for most payers, now is the time to shift your focus to other industry initiatives, such as Stage 2 Meaningful Use. The move to ICD-10 has provided your organization with a breadth of granular codes, and it’s critical that you determine how best to incorporate these codes in your data strategy in order to maximize the benefits of this detailed patient and billing information.

Along with federal legislation, the rise in health information exchanges, ACOs and health insurance exchanges has shed light on the importance of data normalization beyond ICD-10. With interoperability at the heart of each of these initiatives, payers and providers alike will be required to use standardized terminologies for documenting and sharing patient information. Some of the most significant benefits of clinical terminology standardization and management for your organization in a value-based healthcare environment include:

  • More timely and accurate provider reimbursement due to consistent code usage;
  • Decreased administrative costs;
  • Streamlined communication with customers; and
  • Enhanced analytics for identifying cost-effective treatments offered by providers and supporting population health management.

This collaborative approach with providers in your network will be crucial for mitigating financial risks, analyzing large volumes of clinical data and ultimately, improving quality of patient care across the continuum.

To learn more about the role of clinical terminology management in your organization, download our white paper “Clinical Terminology Management: ICD-10 and Beyond.”

 Understand Payer Benefits of Clinical Terminology Management

Topics: ICD-10, HCCs, Medical Plans, LOINC, medical terminology management

About the Author

Kristina Sherwood