ICD-10 Implementation Train Wreck

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ICD-10 Implementation Train Wreck

Health care providers can help minimize the downside cash flow and revenue impacts of ICD-10 by organizing and planning for contracting with Payers in anticipation the change to ICD-10 in October 2013. 

Health care payers will be designing their reimbursement plans for 141,000 new ICD10 codes.  It will be critical for providers to know their required reimbursement for these new codes before they negotiate with Payers who will certainly try to reduce reimbursement.

In this adversarial healthcare environment, health care providers must be proactive in understanding a strategy to avert potential disasters in their reimbursement system.  With the thin margins that most hospitals already operate on, we believe this will be one of the most important aspects of implementing ICD10.  ICD-10 is not just a new diagnostic system of coding; it is more importantly a new reimbursement system.

Here are just a few more to think about:

  • Management some payers and providers apprently still perceive that a GEM (General Equivalence Map) will provide the magic bullet they need to automatically convert their systems from ICD-9.  Unfortunately, this is not true.  GEMs are icomplete because they are based on going from less detail to more.
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  • Recently we talked to a company that felt that if they simply changed the field length in their databases, they would be ready for ICD-10.  Unfortunately this is not the case.
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  • If you rely on an out of network repricer, and your vendor uses automated methods based on historical data, they won’t work under ICD-10.  Significant modifications will be required. 
  • Avoiding the ICD-10 implementation train wreck will be easier if your company is doing an assessment of the business, process, system, clinical and IT impacts early in this process.  Conversely, those health insurance firms, hospitals, clinics, physician groups and other entities who are proactive in seeing an ICD-10 assessment as an avenue to improved revenue and cash flow will be better positioned strategically when the market shifts.

    If you do not believe you have these skills in house, look to partner with a consulting team that has the process, people, methods and tools to successfully navigate this new reimbursement system.

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    By | 2017-05-04T04:07:00+00:00 September 15th, 2010|ICD-10, ICD-10 Assessment, ICD-10 Implementation, Reimbursement|0 Comments

    About the Author:

    Michael is Managing Partner & CEO of No World Borders, a leading health care management and IT consulting firm. 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 $4 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, Stanford Medical School - Biomedical Informatics, Harvard Law School - Bioethics.
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