ICD-10 Financial Impacts for All HIPAA Covered Entities
No World Borders Comprehensive Approach to ICD-10 Analysis includes these and more components
ICD-10 Financial impacts span all parts of payers and providers. Based on No World Borders broad experience in ICD-10 and health care, we have developed services and solutions to meet your needs as a HIPAA Covered Entity (both health plans and providers), as well as Health IT companies and investors.
ICD-10 Impact Assessments should include an understanding of:
- ICD-10 Impact to Revenue Cycle Management
- ICD-10 DRG shifts
- ICD-9 to ICD-10 mapping risk
- ICD-10 impact based on use of unspecified codes
- Health Information Technology (HIT) Impacts:
- ICD-10 Impact on the Health Information Management (HIM) Department
- ICD-10 Impact to IT, as distinct from the clinical applications, such as resource conflicts
- ICD-10 Impacts on training budgets, which should include the Human Resources Department
- ICD-10 Risk and Impacts to denial management with respect to payer relations and contracting
ICD-10 for Providers
ICD-10 Analysis should include a review of key processes, including:
- ICD-10 impacts medical billing and medical coding
- Provider Scheduling
- ICD-10 Impacts relative to Provider workflows and clinical operations
- ICD-10 Financial Impacts relative to coding and charge capture
- ICD-10 Impacts relative to chargeback and work queues
- physician queries
- pre-bill edits
- claim submission
- ICD-10 Impacts relative to the appeals process
- ICD-10 Impacts relative to bad debt write-offs
- ICD-10 Impacts relative to decision support
- ICD-10 Financial Impacts relative to compliance, legal, and reporting
- And 30 other categories
ICD-10 for Inpatient and Outpatient
System-level issues, NPIs, and charts audits based on the ICD-10 Risk Reporting should be used to select high volume, high dollar, high unspecified, and other criteria
ICD-10 Financial Impacts for Health Plans
Health plans should review:
- ICD-10 Impacts related to underwriting
- ICD-10 Impacts related to explanation of benefits (EOBs)
- ICD-10 Impacts related to actuarial
- ICD-10 Impacts related to claims processing, including denials and delayed reimbursement
- ICD-10 Impacts related to lack of provider readiness and ICD-9 codes submitted after the mandated compliance time frame
- ICD-10 Impacts related to clearing house coordination and provider testing
- ICD-10 Impacts related to dual coding in ICD-9 and ICD-10
Related Posts
- ICD-10 Financial Risk Assessment and and ICD-10 Crosswalk Using ICD-10 Predictive Analytics
- ICD-10 Financial Risk Assessment and Data Quality – Why You Need it and How to Get Started
- ICD-10 Financial Risk Assessment by Service Line
- ICD-10 Financial Risk Assessment, Case Management, RAC Audits, Dual Eligibles
- ICD-10 Financial Risk Assessment, Process Risk – ICD-10 diagnosis and ICD-10 procedure codes, provider patient scheduling workflow
Related Post from U.S. Department of Health and Human Services (“HHS”) Centers for Medicare and Medicaid Services (“CMS”).Benefits of ICD-10 (CMS Guide for Small Hospitals)