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 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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Icd 10 implementation readiness and revenue cycle analytics

  1. 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. 2. ICD-10 Topics <ul><li>Organization readiness </li></ul><ul><li>Organization impacts </li></ul><ul><li>Clinical integration and the revenue cycle </li></ul><ul><li>ICD-10 and analytics </li></ul><ul><li>Clinical scenarios </li></ul>http://www.noworldborders.com
  3. 3. Most Payers & Providers and Vendors Are Under Estimating the Joint Requirement & Analysis Time for 5010 and ICD-10 <ul><li>Coordinated preparation </li></ul><ul><li>Elevated role of the coder </li></ul><ul><li>“ RAC” or Revenue Audit Contractor (CMS </li></ul><ul><li>ICD-10 will change RAC issues </li></ul><ul><li>Change to clinical benchmarking </li></ul><ul><li>Disparities, siloed RCM systems </li></ul>http://www.noworldborders.com/HIPAA5010MigrationServices.html
  4. 4. ICD-10 Organizational Impact http://www.noworldborders.com/HIPAA5010MigrationServices.html
  5. 5. Understanding Stakeholder Impacts <ul><li>Medical coder </li></ul><ul><li>Nursing </li></ul><ul><li>Case managers </li></ul><ul><li>Physicians </li></ul><ul><li>Health IT </li></ul>http://www.noworldborders.com
  6. 6. Organizational Capabilities Checklist <ul><li>Clinical Integration with Revenue Cycle </li></ul><ul><li>Remediation Plan for ICD-10 </li></ul><ul><li>Understanding of Contracted Health Plan Medical Policy changes under ICD-10 </li></ul>
  7. 7. Organizational Capabilities Checklist <ul><li>Claims Coding & Authorizations </li></ul><ul><li>Case Management Expertise </li></ul><ul><li>Experience with vendor chosen claims system </li></ul><ul><li>Experience with case management tools </li></ul><ul><li>Experience working with ICD-10 in other countries </li></ul>
  8. 8. Organizational Capabilities Checklist <ul><li>Claims Adjudication </li></ul><ul><li>CMS view </li></ul><ul><li>Fraud analytics </li></ul><ul><li>ICD-10 Strategy </li></ul><ul><li>Data Warehouse </li></ul>
  9. 9. Organizational Capabilities Checklist <ul><li>Business Intelligence </li></ul><ul><li>Regulatory expertise </li></ul><ul><li>Remediation areas checklist </li></ul><ul><li>Training </li></ul><ul><li>GEMS, Crosswalks – (cheap, sub-optimal) </li></ul><ul><li>Vocabulary & nomenclature </li></ul><ul><li>Medical Concepts and Medical Policy </li></ul>
  10. 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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