ICD-10 Implementation and Medical Management are Co-mingled with Revenue Cycles

Implementing ICD-10 is more than just IT. Medical management and the opportunity to improve case management and pre-authorizations, decrease appeals, allow pre-authorization policy to increase auto adjudication allows for more “one and done” and touch-less claims.

If you aren’t looking at medical policy management and its inter-twined relationship with ICD-10, then you are not by definition looking at revenue cycle management either.   Our firm has been working with clients on HIPAA 5010 and ICD-10 preparedness, and also behind the scenes we have spent quite a bit of time looking at medical concepts and their relationships to ICD-9 and how those change in ICD-10.  Our past work in SNOMED has helped.   Medical policies in XML, working in ways we cannot now conceive of will become common place in the future.

Systems implemented without looking at the way ICD-10 can help your company innovate will be leaving value on the table. ICD-10 implementations should be both about a view of the minimum to comply and the extra value that can be gained. He who implements ICD-10 without a thorough grasp of these issues is doomed to substandard results. Medical management under ICD-10 will require a new view of clinical data and an audit trail from ICD-9 to ICD-10. An ICD-10 assessment from a knowledgeable company can help show where opportunities are for your company.

We urge you to start the process now if you haven’t. It is more complex than you think.  We understand, if you are a payor membership has declined, budgets are tighter.  If you are a hospital or other type of provider, you most likely have been working on Meaningful Use and Electronic Health Records.  Getting started with a business roadmap and a relatively small investment in an ICD-10 Assessment with our firm can be a good way to start.  Contact us now at [email protected] to start the conversation.

Michael Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. He leads a team that provides Cybersecurity best practices for healthcare clients, ICD-10 Consulting, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, Insurance Fraud, payor-provider disputes, and consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, stutdies at Harvard Law School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims).

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