ICD-10 Financial Impact Assessment

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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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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