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.
One strategy is to continue to move ahead on ICD-10 process impacts, systems planning, and overall budgets but depending on readiness, get your consulting firm to help with both the requirements documentation and strategies for clinical documentation that don’t’ exist now. Why? The WEDI / NCHICA timeline suggests that health care providers should have started planning for ICD-10 about 18 months before the CMS announcement of a delay.
We find that most analytics and revenue cycle companies are ignoring the future role coordinated medical coding will have, the transition to ICD-10, and the clinical documentation and processes on the revenue cycle. The ICD-10 transition will re-write the book on revenue cycle management (RCM). RAC audits and Electronic Medical Records (EMRs) will be subject to a new paradigm with ICD-10.
ICD-10 creates challenges for health plans who want to transition successfully from ICD-9 with respect to defining and redefining medical policy. This presentation addresses best practice approaches