An ICD-10 Impact Assessment can take several forms depending on the type of organization:

1. Health Care Provider

Just a few of the considerations regarding ICD-10 for providers are listed below

  • Setting (inpatient, outpatient)
  • Type of health plans contracted with (Medicare, Medicaid, Commercial)
  • Medical specialty (some medical specialties are impacted more by ICD-10 than others)
  • Medical records systems
  • Other impacted systems
  • Clinical documentation quality benchmarking and improvement
  • Physician training for ICD-10 by medical specialty
  • Revenue cycle management
  • Financial risk assessment
  • Business continuity
  • ICD-10 testing
  • Intersection of ICD-10 and Meaningful Use

2. Health plan

A few considerations for ICD-10 impacts for health plans are listed below

  • Medicare Advantage
  • Self-insured employer
  • Other commercial plan
  • Type of provider contracts
  • Local, State, and Federal regulations
  • Medical loss ratio
  • Medical policy
  • Coverage determinations
  • First pass rate objectives for post ICD-10 claims processing
  • Financial risk assessment
  • Business continuity
  • ICD-10 testing

3. Health IT firm

Health IT firms supporting payors and providers should consider, among other things for ICD-10 the following:

  • Electronic health record (EHR) vendor
  • Analytics vendor
  • Target markets served (Provider, Plan [considerations above])
  • Approach to supporting ICD-9, CPT, and ICD-10 from a data ontology standpoint
  • Intersection of Meaningful Use, Clinical Quality Measures (CQMs), Clinical Decision Support, and ICD-10
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