For Providers, Revenue Assurance through the ICD-10 Transition is Key

The following is a guest blog post by Vik Anantha, Vice President – Financial Management Solutions, Edifecs, Inc. We all know ICD-10 is a complex and costly initiative. One of the promises of ICD-10 is the potential for enhanced granularity, laterality and overall reporting accuracy. This is particularly important to providers because health plans use the ICD code set to determine reimbursements based on the medical condition of the patient and procedure(s) used for treatment. With promise comes risk. ICD-10 not only exponentially increases the number of diagnostic and procedure codes, it changes the structure of the coding scheme and introduces new clinical concepts, terminology and granularity. These widespread changes will force business process and policy changes in areas such as benefits, medical management, and payer contracting. In other words, ICD-10 will affect almost every operational, clinical and financial process. On the business side of ICD-10, revenue neutrality is a big concern for healthcare CFOs and revenue cycle management leaders. While it’s unrealistic to expect revenue neutrality at a claim level (there will always be some variation), it’s entirely possible to achieve revenue neutrality in aggregate. And this should be the goal. It won’t be easy. Improper and incomplete coding can increase denial rates, causing significant revenue loss. Even error-free claims hold financial risk, particularly for healthcare organizations that depend on DRG (diag...
Source: EMR and HIPAA - Category: Technology Consultants Authors: Tags: Healthcare HealthCare IT ICD-10 CDI Clinical Documentation Improvement Edifecs Healthcare CFO ICD-10 Mandate ICD-9 Vik Anantha Source Type: blogs