ICD-10 Consulting Shift to Testing and Revenue Impacts

ICD-10 consulting will shift in the next year from IT–centric to testing and revenue impacts.   Many ICD-10–ready IT systems, providers and payers won’t know if they really have an end to end solution until they test using ICD-10 claims that are based on documentation that is coded in ICD-10.

ICD-10 revenue cycle management impacts for providers and ICD-10 based coverage determinations for health plans are only hypothetical until they are tested.

ICD-10 consulting efforts, in our experience are subject to the regulatory delays and human nature being what it is, there was a lull in activity after the delay.  Now that we are within a year of the October 1, 2015 mandate, we expect to see more ICD-10 consulting work that is focused on ensuring end-to-end electronic claims processing actually works.  The financial impact of ICD-10 is still under-estimated.

ICD-10 analytics in an ICD-10 risk assessment will be helpful to examine assumptions made in ICD-10 cross walks.  ICD-10 data integrity will also be important to review.  The ICD-10 implementation plan should include a review of ICD-10 CM diagnosis codes, which will be important for all care providers whether acute care or outpatient care.  ICD-10 PCS procedure codes will be important for inpatient care.  Testing of these assumptions is the only way to assure business continuity under ICD-10.

Below is an article I wrote on ICD-10 financial impacts:

http://www.govhealthit.com/news/could-icd-10-have-big-financial-impact-mortgage-crisis

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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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