ICD-10 Crosswalk using ICD-10 Predictive Analytics

ICD-Financial Risk Assessments should quantify both enterprise risk and ICD-10 risk related to each specialty and each area of ICD-10 clinical documentation.

Our founder and CEO Michael Arrigo wrote an in-depth macroeconomic analysis of ICD-10 financial risk entitled, Could ICD-10 Have as Big an Impact as the Mortgage Crisis?  Yes.  Here’s Why.   Later, he was retained by a group of PhDs in Economics, a law firm, and a leading healthcare IT firm to assist in a Federal Trade Commission involving ICD-10’s economic impact, access to clinical data, and computer assisted coding.

From this vision, and these experiences our firm developed a strategy, analytics solutions and partnerships to deliver Clinically Integrated Analytics ™ that enable you to understand not only your ICD-10 Financial Risk but your ICD-10 specialty risk and ICD-10 audit risk.  In addition we provide visibility into cost reducing opportunities in other areas of the health plan and health care provider’s operation using this analytic approach.

ICD-10 Crosswalk – Not a Panacea

Now that some health plans and health care providers have completed their ICD-10 Assessments many are trying to determine what to remediate and how to selectively prioritize ICD-10 clinical documentation improvement for health care providers.  Health plans are prioritizing their ICD-10 remediations and should be looking at their claims mix and contracted providers as well as test plans.  An ICD-10 Financial Risk Assessment should be a part of the ICD-10 Implementation Plan for a smooth ICD-10 transition.

Analytics can help.  We continue to caution HIPAA Covered Entities on using magic ICD-10 crosswalk tools.

ICD-10 Predictive Analytics

ICD-10 Analytics can be used to help prioritize reimbursement variation.

ICD-10 Financial Risk Assessment – Apply ICD-9 and ICD-10 Predictive Analytics Synergistically

When reviewing claims, our approach is unique in that we review reimbursement risk by specialty in ICD-9 vs ICD-10, out of network claims, clinical notifications for specialties where reduction of malpractice insurance opportunities exist, and other factors.

Therefore your investment in ICD-9 claims analytics and ICD-10 consulting is leveraged, and usually we find much greater savings than the client invests in fees for our work.

Contact us for more information.

Related Posts

ICD-10 Financial Risk Assessment – Comprehensive Approach

Michael F. 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. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, 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, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA 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, studies at Harvard Medical 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). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.

Leave a Reply