ICD-10 consulting will shift to testing and revenue cycle impacts in the next few months. Testing is the only way to ensure business continuity.
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.
Does your organization have Standard Operating Procedures (SOPs) that use ICD-9 CM diagnosis or ICD-9 procedure code information? If so, those procedures and systems need to be evaluated as part of the ICD-10 Impact Assessment.
ICD-10 Assessments today need a faster start because there is less time to spare to get ready for the October 1, 2014 2015 deadline. What you don’t know can hurt…
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
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.
Clinicians should be leaders in the healthcare industry by providing accurate data, accurate analysis of the data and change in healthcare to continuously improve the value their patients receive.
ICD-10 clinical scenarios can be used to understand potential risks and variations in reimbursement for procedures that are provided after October 1, 2013.
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.
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.