ICD-10 Consulting Shift to Testing and Revenue Impacts

ICD-10 consulting will shift in the next year from IT–centric to testing and revenue impacts.   Many ICD-10–ready IT systems, providers and payers won’t know if they really have an end to end solution until they test using ICD-10 claims that are based on documentation that is coded in ICD-10.

ICD-10 revenue cycle management impacts for providers and ICD-10 based coverage determinations for health plans are only hypothetical until they are tested.

ICD-10 consulting efforts, in our experience are subject to the regulatory delays and human nature being what it is, there was a lull in activity after the delay.  Now that we are within a year of the October 1, 2015 mandate, we expect to see more ICD-10 consulting work that is focused on ensuring end-to-end electronic claims processing actually works.  The financial impact of ICD-10 is still under-estimated.

ICD-10 analytics in an ICD-10 risk assessment will be helpful to examine assumptions made in ICD-10 cross walks.  ICD-10 data integrity will also be important to review.  The ICD-10 implementation plan should include a review of ICD-10 CM diagnosis codes, which will be important for all care providers whether acute care or outpatient care.  ICD-10 PCS procedure codes will be important for inpatient care.  Testing of these assumptions is the only way to assure business continuity under ICD-10.

Below is an article I wrote on ICD-10 financial impacts:

http://www.govhealthit.com/news/could-icd-10-have-big-financial-impact-mortgage-crisis

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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