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Archive for the ‘ICD-10 PCS’ Category

ICD-10 Consulting Shift to Testing and Revenue Impacts

Friday, October 17th, 2014

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 it 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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ICD-10 Impacts Case Management and Case Management Reporting

Thursday, January 30th, 2014

ICD-10 assessment and implementation planning activities create many possible areas to focus on so it is important to prioritize those that are most critical to patient care and reimbursement.

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.  The member or patient, provider, case management RN, and dedicated Medical Director,  and Case Reviewers all collaborate in this process.   Therefore, the transition to ICD-10 creates just one more reason to take a closer look at Case Management and Case Management reports.

In our over 30 years’ experience in software development, IT systems and healthcare IT, we have found that reporting is one of the most overlooked areas by developers of solutions like these, but one of the most critical for users of these systems.

Does your organization depend on reports for Case Management?  If so any ICD-9 related information in those reports will need to be updated for ICD-10 if they contain procedure codes or diagnosis codes in ICD-9 today.

Some of the impacted systems, and processes to consider include:

  • Referrals (Utilization Management, Condition Management, Self-referrals, Client requests, Provider requests, etc.)
  • Targeted high volume, high cost, high risk diseases
  • Analytics, including predictive modeling, ICD-10 financial risk analytics, and population health management analytics
  • Clinical decision support
  • Plan compliance reporting
  • Inpatient reporting (bed days, denials, readmissions)
  • Shared savings, bundle payments, capitation, PMPM
  • Cost reporting (fee for service, case based, benchmarked, per diem)
  • Medicare Advantage specific measures (HEDIS, 5-Star Ratings)
  • Home health care
  • Medical necessity
  • DME
  • and more

Related Posts and Resources

  1. Case Management Guide for Providers from CMS
  2. Case Management, RAC Audits, Revenue Cycle Management and ICD-10
  3. ICD-10 Consulting
  4. ICD-10 Financial Risk Management
  5. ICD-10 Assessment and Data Quality
  6. ICD-10 Remediation
  7. ICD-10 and Interoperability
  8. ICD-10 Best Practices

 

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