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.
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
ICD-10 Financial Risk Assessments should include an analysis of historical healthcare claims data for one, two, or ideally three retrospective periods. A data quality assessment is essential, making sure that claims are not duplicates, and that they therefore represent unique events. This is particularly important in view of interim billing on hospital claims. It’s very easy to count hospital admissions multiple times from claims data unless you reconcile claims to a single hospital stay.
By June 13, 2013 only three vendors are ready for inpatient, and three for ambulatory on the CMS website that shows which EHR vendors have their product certified for Meaningful Use under the 2014 Standard. This creates an issue for all Eligible Providers (EPs) who achieved meaningful use Stage 1. Unless their EHR vendor meets the Stage 2 requirements, those EPs no longer qualify for Meaningful Use stimulus dollars.
The College of Health Information Management Executives (CHIME), proposed a one-year extension of Meaningful Use Stage 2 in response to Senators’ request for feedback on healthcare IT adoption. Note that an actual extension would requre an Act of Congress, according to the Stage 2 Final Rule.
"At the same time, physicians should make preparations for the new code set to avoid disastrous results if ICD-10 is rolled out as planned. Those who aren't ready by next year's deadline will not receive payment for their services." We recommend that all HIPAA Covered Entities continue to prepare for ICD-10.
ICD-10 will impact scheduling workflow. If your current systems capture ICD-9 codes, your IT team will need to remediate and test scheduling systems. Ultimately, an ICD-10 Financial Risk Assessment, ICD-10 testing, and ICD-10 implementation plan should comprehend ICD-10 provider scheduling.
ICD-10 transition has several impacts that many health plans and health care providers will not consider, unless they are doing a comprehensive assessment of all systems and processes. If ICD-9 diagnosis coding (ICD-9 CM) and ICD-9 procedure codes are included in the workflow.
If you are in a CoC hospital registry, you are also collecting complications and co morbidities, which are ICD-9-CM codes. These codes will be replaced by ICD-10-CM.
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 clinical documentation improvement for health care providers. Health plans are prioritizing their remediations and should be looking at their claims mix and contracted providers as well as test plans. An ICD-10 Risk Assessment using ICD-9 and ICD-10 predictive analytics can help.
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