ICD-10 Financial Impacts for All HIPAA Covered Entities

 

No World Borders Comprehensive Approach to ICD-10 Financial Impact Analysis includes these and more components

Based on No World Borders broad experience in ICD-10 and health care, we have developed services and solutions to meet your needs as a HIPAA Covered Entity (both health plans and providers) as well as Health IT companies and investors.

ICD-10-Financial-Risk-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

ICD-10 Financial Impacts for Providers

  • ICD-10 Financial Impact Analysis should include a review of key processes including:
  • ICD-10 Financial Impacts relative to Provider scheduling
  • ICD-10 Financial Impacts relative to Provider workflows and clinical operations
  • ICD-10 Financial Impacts relative to coding and charge capture
  • ICD-10 Financial Impacts relative to charge back and work queues
  • ICD-10 Financial Impacts relative to physician queries
  • ICD-10 Financial Impacts relative to pre-bill edits
  • ICD-10 Financial Impacts relative to claim submission
  • ICD-10 Financial Impacts relative to appeals process
  • ICD-10 Financial Impacts relative to bad debt write offs
  • ICD-10 Financial Impacts relative to decision support
  • ICD-10 Financial Impacts relative to compliance, legal and reporting
  • And 30 other categories

ICD-10 Financial Impacts for Inpatient and Outpatient

System level issues, NPIs, and charts audits based on the ICD-10 Risk Reporting should be used to select high volume, high dollar, high unspecified, and other criteria

ICD-10 Financial Impacts for Health Plans

Health plans should review:

  • ICD-10 Impacts related to underwriting
  • ICD-10 Impacts related to explanation of benefits (EOBs)
  • ICD-10 Impacts related to actuarial
  • ICD-10 Impacts related to claims processing including denials and delayed reimbursement
  • ICD-10 Impacts related to lack of provider readiness and ICD-9 codes submitted after the mandated compliance time frame
  • ICD-10 Impacts related to clearing house coordination and provider testing
  • ICD-10 Impacts related to dual coding in ICD-9 and ICD-10
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