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 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 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.
Summary financial risk information Financial impact data by physician, coder , facility, specialty, to prioritize training and staffing decisions Encounter-level analytics to prioritize clinical documentation improvement process, testing, and compliance activities Payor contract data organized by reimbursement variations Code-level analysis to drive remediation Trending and ICD-10 financial risk benchmarks
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.
Now that some health plans and health care providers have completed their ICD-10 Assessments many are trying to determine what to remediate and how to selectively prioritize clinical documentation improvement for health care providers. Health plans are prioritizing their remediations and should be looking at their claims mix and contracted providers as well as test plans. An ICD-10 Risk Assessment using ICD-9 and ICD-10 predictive analytics can help.