ICD-10 assessment and implementation planning activities create many possible areas to focus on so it is important to prioritize those that are most critical to patient care and reimbursement.
When thinking about ICD-10 program governance, one of the key areas for both traditional Fee for Service (FFS) medicine and the transition to episodic (short-term) and longitudinal data for comparative effectiveness medicine in the Affordable Care Act is the Case Management process and supporting software and reports. The member or patient, provider, case management RN, and dedicated Medical Director, and Case Reviewers all collaborate in this process. Therefore, the transition to ICD-10 creates just one more reason to take a closer look at Case Management and Case Management reports.
In our over 30 years’ experience in software development, IT systems and healthcare IT, we have found that reporting is one of the most overlooked areas by developers of solutions like these, but one of the most critical for users of these systems.
Does your organization depend on reports for Case Management? If so any ICD-9 related information in those reports will need to be updated for ICD-10 if they contain procedure codes or diagnosis codes in ICD-9 today.
Some of the impacted systems, and processes to consider include:
- Referrals (Utilization Management, Condition Management, Self-referrals, Client requests, Provider requests, etc.)
- Targeted high volume, high cost, high risk diseases
- Analytics, including predictive modeling, ICD-10 financial risk analytics, and population health management analytics
- Clinical decision support
- Plan compliance reporting
- Inpatient reporting (bed days, denials, readmissions)
- Shared savings, bundle payments, capitation, PMPM
- Cost reporting (fee for service, case based, benchmarked, per diem)
- Medicare Advantage specific measures (HEDIS, 5-Star Ratings)
- Home health care
- Medical necessity
- and more