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Icd 10 implementation readiness and revenue cycle analytics

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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 …

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.

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  • 1. ICD-10 Implementation Readiness Revenue Cycle Analytics Medical Policy   October 2011 http://www.noworldborders.com Mike Arrigo Managing Partner, CEO No World Borders, Inc. For more details, assessment info [email_address] (Please send from your payor or provider email domain address)
  • 2. ICD-10 Topics
    • Organization readiness
    • Organization impacts
    • Clinical integration and the revenue cycle
    • ICD-10 and analytics
    • Clinical scenarios
    http://www.noworldborders.com
  • 3. Most Payers & Providers and Vendors Are Under Estimating the Joint Requirement & Analysis Time for 5010 and ICD-10
    • Coordinated preparation
    • Elevated role of the coder
    • “ RAC” or Revenue Audit Contractor (CMS
    • ICD-10 will change RAC issues
    • Change to clinical benchmarking
    • Disparities, siloed RCM systems
    http://www.noworldborders.com/HIPAA5010MigrationServices.html
  • 4. ICD-10 Organizational Impact http://www.noworldborders.com/HIPAA5010MigrationServices.html
  • 5. Understanding Stakeholder Impacts
    • Medical coder
    • Nursing
    • Case managers
    • Physicians
    • Health IT
    http://www.noworldborders.com
  • 6. Organizational Capabilities Checklist
    • Clinical Integration with Revenue Cycle
    • Remediation Plan for ICD-10
    • Understanding of Contracted Health Plan Medical Policy changes under ICD-10
  • 7. Organizational Capabilities Checklist
    • Claims Coding & Authorizations
    • Case Management Expertise
    • Experience with vendor chosen claims system
    • Experience with case management tools
    • Experience working with ICD-10 in other countries
  • 8. Organizational Capabilities Checklist
    • Claims Adjudication
    • CMS view
    • Fraud analytics
    • ICD-10 Strategy
    • Data Warehouse
  • 9. Organizational Capabilities Checklist
    • Business Intelligence
    • Regulatory expertise
    • Remediation areas checklist
    • Training
    • GEMS, Crosswalks – (cheap, sub-optimal)
    • Vocabulary & nomenclature
    • Medical Concepts and Medical Policy
  • 10. Mike Arrigo Managing Partner, CEO No World Borders, Inc. For more details, assessment info [email_address] (Please send from your payor or provider email domain address)

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