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Gap Analysis

ICD-10 Gap Analysis includes a review of organization, process, people and systems as well as external entities that the HIPAA covered entity interacts with in the exchange of clinical, claims and financial data.

ICD-10 Gap Analysis may include:

  1. Organization gap analysis (ICD-10 training, management readiness)
  2. ICD-10 IT Vendor Assessment
  3. ICD-10 related process impacts
  4. ICD-10 governance planning
  5. ICD-10 impacted processes
  6. ICD-10 clinical documentation quality to support documentation of medical necessity and diagnosis related groupings (DRGs)
  7. ICD-10 clinical documentation quality to support documentation of medical necessity for ambulatory and professional fee claims (ICD-10 CM and CPT coding)
  8. For Medicare and Medicare Advantage providers, quality measures that will directly impact reimbursement under Affordable Care Act (HCC, RAPS, RAFS, HEDIS scores)
  9. ICD-10 testing readiness
  10. ICD-10 contracting plans
  11. ICD-10 physician change management and education (both employed and non-employed groups, by specialty)
  12. ICD-10 financial risk assessment and risk mitigation plans

…and more

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