ICD-10 Financial Impact Assessment

ICD-10 Financial Impact Assessments should include an understanding of: ICD-10 Financial Impact to Revenue Cycle Management ICD-10 Financial Impact based on DRG shifts ICD-10 Financial Impact based on ICD-9 to ICD-10 mapping risk ICD-10 Financial Impact based on use of unspecified codes Health Information Technology (HIT) Impacts: ICD-10 Financial Impact to the Health Information Management (HIM) department ICD-10 Financial Impact to IT as distinct from the clinical applications such as resource conflicts ICD-10 Financial Impacts to training budgets, which should include the Human Resources Department ICD-10 Financial Risk and Impacts to denial management with respect to payer relations and contracting

Continue ReadingICD-10 Financial Impact Assessment

Will Healthcare Go the Way of Farming in the U.S.?

a focus on income support has remained constant. We can assume that based on recent U.S. policy certain incentives and regulations will continue in healthcare and that the general effect will be to encourage scale and specialization. The main difference between healthcare and agriculture is that interoperability is essential for the former and will create cooperatives focused on data sharing just as in agriculture smaller providers have historically joined forces to achieve economies of scale and reduce redundant processes.

Continue ReadingWill Healthcare Go the Way of Farming in the U.S.?

September 11th Anniversary – Triumph of American Spirit Sets Tone for Future and Upcoming National Health IT Week

The 9/11 Anniversary this year appears to be dominated by hope for the future.  In this remarkable time lapse photography you can see what America can do when it puts…

Continue ReadingSeptember 11th Anniversary – Triumph of American Spirit Sets Tone for Future and Upcoming National Health IT Week

Figliozzi and Company Meaningful Use Audits – CMS Designee Can Take Back Incentive Funds

Despite recent writings by some law firms, a failed Meaningful Use audit ("final determination") is a serious affair, requiring the attesting organization to immediately pay 100% of the Meaningful Use incentive funds back to CMS. For a $500 million hospital system, for example, this is likely to be $millions.

Continue ReadingFigliozzi and Company Meaningful Use Audits – CMS Designee Can Take Back Incentive Funds

ICD-10, Case Management, Revenue Cycle Management, RAC Audits, and Dual Eligbles

Case Management should benefit the entire system, bridging clinical and financial ares of healthcare. Underlying Case Management processes are a number of functions. Case Management also relies on specific diagnosis codes. If hard-coded information or ICD-9 specific methods of capturing this information are in Case Management Systems, they will need to be remediated or replaced to support ICD-10.

Continue ReadingICD-10, Case Management, Revenue Cycle Management, RAC Audits, and Dual Eligbles

ICD-10 Arrives Early – April 1, 2014: CMS Announces New CMS-1500 Healthcare Claim Form

Starting April 1, 2014, Medicare will accept only the revised version of the form. The revised form will give HIPAA Covered Entities who are health care providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes, which is important as the October 1, 2014, transition approaches. Effectively this means that any healthcare IT system that was scheduled to be compliant as of October 1, 2014 with ICD-10 must actually comply with a component of the ICD-10 requirements early as of April 1, 2014.

Continue ReadingICD-10 Arrives Early – April 1, 2014: CMS Announces New CMS-1500 Healthcare Claim Form

Hospital Readmissions Penalties Interactive Table

Update August 2, 2013 - CMS published a list of 2,225 hospitals in 49 states that will lose up to 2% of their Medicare reimbursement that had too many patient readmission within 30 days of discharge because of three medical conditions: heart attack, heart failure and pneumonia. Under the PPACA, the maximum penalty will increase to 3% by 2015 and expand to include re-admissions for other medical conditions. ICD-10, a standard the describes the condition of the patient, will modify these quality measures when it goes into effect. We have published an interactive, searchable version of the penalties, by city, state, county and hospital for the healthcare industry and consumers to use to easily find the data relevant to their geography or organization.

Continue ReadingHospital Readmissions Penalties Interactive Table

Increasing Health Data Interoperability, BigData, Cloud, Exchange, ICD-10 Lay Foundation for Accountable Care

These are important foundations that enable ubiquitous digital health data in a standard interchange, enabling in-depth analysis and increasingly, Cloud and Software as a Service methods to deploy, store and use the information to improve healthcare. These in turn are important foundations to enable Accountable Care. ICD-10 is the new data standard that will express the condition of the patient and how providers get reimbursed.

Continue ReadingIncreasing Health Data Interoperability, BigData, Cloud, Exchange, ICD-10 Lay Foundation for Accountable Care

Assessing ICD-10 Financial Risk by Service Line

ICD-10 transition and risk assessment best practice by service line: Physician engagement, combined with chart audits and analytics must be used carefully in a balanced method to ensure that the ICD-10 transition works smoothly across service lines, physician groups, and financial management.

Continue ReadingAssessing ICD-10 Financial Risk by Service Line

ICD-10 Financial Risk Assessment and Data Quality – Why You Need it and How to Get Started

Summary financial risk information Financial impact data by physician, coder , facility, specialty, to prioritize training and staffing decisions Encounter-level analytics to prioritize clinical documentation improvement process, testing, and compliance activities Payor contract data organized by reimbursement variations Code-level analysis to drive remediation Trending and ICD-10 financial risk benchmarks

Continue ReadingICD-10 Financial Risk Assessment and Data Quality – Why You Need it and How to Get Started