HR 2156, the Medicare Audit Improvement Act of 2015 legislation proposes changes to the Recovery Audit Contractor (RAC) program just in time for ICD-10
ICD-10 consulting will shift to testing and revenue cycle impacts in the next few months. Testing is the only way to ensure business continuity.
ICD-10, the International Classification of Diseases version 10 from the World Health Organization (WHO) is supposed to go into effect in the United States on October 1, 2014 2015. Today on Twitter, proponents of ICD-10 asked the U.S. Senate not to delay ICD-10 as part of H.R. 4302. H.R. 4301 is designed primarily to re-adjust the [...]
ICD-10 (International Classification of Diseases version 10 developed by the World Health Organization or WHO) code set has the potential to bring new analytical capability to pharmaceutical and medical device companies eager to improve efficiency and to differentiate themselves in the new regulatory economy. Today’s pharmaceutical and medical device company analytic capabilities are not sufficient [...]
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.
ICD-10 Assessments today need a faster start because there is less time to spare to get ready for the October 1, 2014 2015 deadline. What you don’t know can hurt your reimbursement if you are a provider, and put you at risk of fines if you are a payor. For most health care providers, [...]
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 transition and risk assessment best practice by service line: Physician engagement, combined with chart audits and analytics must be used carefully in a balanced method to ensure that the ICD-10 transition works smoothly across service lines, physician groups, and financial management.
ICD-10 Financial Risk Assessments should include an analysis of historical healthcare claims data for one, two, or ideally three retrospective periods. A data quality assessment is essential, making sure that claims are not duplicates, and that they therefore represent unique events. This is particularly important in view of interim billing on hospital claims. It’s very easy to count hospital admissions multiple times from claims data unless you reconcile claims to a single hospital stay.
ICD-10 will impact scheduling workflow. If your current systems capture ICD-9 codes, your IT team will need to remediate and test scheduling systems. Ultimately, an ICD-10 Financial Risk Assessment, ICD-10 testing, and ICD-10 implementation plan should comprehend ICD-10 provider scheduling.
The significant increase in code classifications will affect how departments function within themselves, with each other and with outside organizations. As payers take the time to become educated about ICD-10 and 5010, it becomes clear that the impacts are not contained within one area of the business, such as claims.
ICD-10 Assessments should lead to actionable approaches using an ICD-10 Financial Risk Assessment, ICD-10 Business roadmap, ICD-10 training for coders, ICD-10 training for physicians, ICD-10 specialty training, ICD-10 vendor readiness, ICD-10 test plan, ICD-10 test data, and an ICD-10 pre-go-live ICD-10 risk assessment. More and more health care companies are realizing that as the deadlines [...]