The steps that we outline will help a provider gain better visibility into reimbursements; manage their workforce, manage payor contracts, and optimize processes under the new code set.
Atlanta, GA (PRWEB) March 27, 2014
Now that CMS has held firm on the October 1, 2014 ICD-10 compliance deadline, providers are starting to think critically about life with ICD-10. Key to this new reality is a provider’s ability to manage and monitor operational and financial health. As providers work to stabilize under the new code set, they will need visibility into just how well they are performing in the new data landscape.
Jvion—the ICD-10 analytics leader—recently produced a report on how to manage and monitor ICD-10 data to enable the greater analytic power promised by the new code set. The full report, which will be presented during this year’s AHIMA ICD-10-CM/PCS & CAC Summit April 22-23 in Washington DC, will cover the challenges and opportunities that come with the anticipated data explosion associated with ICD-10’s greater granularity.
“The steps that we outline will help a provider gain better visibility into reimbursements; manage their workforce, manage payor contracts, and optimize processes under the new code set,” explained Ritesh Sharma, Jvion’s COO and coauthor of the report. During the hour-long presentation, Jvion will discuss the importance of monitoring and reporting on:
- Historical trend analytics
- Financial, case mix, and DRG variations between ICD-9 and ICD-10 reimbursements
- Contractual variations
- Patient account status-based variations
- Denials metrics
- Revenue cycle and AR metrics
- Productivity measures
“Having a system in place to quickly measure and report on these key metrics will be essential to a provider’s success, especially in the first few months following the conversion,” said Ritesh. He also citied some of the risks related to what many are calling the ICD-10 blackout period: the first 90 days after October 1. These include productivity drops, uncertainty about documentation quality and medical necessity, a heavy reliance on outside resources, the need for extra cash on hand, and increased stress for resources across every major department and specialty.
For more information on the AHIMA ICD-10-CM/PCS & CAC Summit, visit the event website at http://www.ahima.org/events/2014April-ICD-10-CAC. And for more information about Jvion, please visit jvion.com.
Jvion is a healthcare technology company that develops software designed to predict and prevent patient-level disease and financial losses leading to increased waste. The company offers a suite of big-data enabled solutions that combine clinical intelligence with deep machine learning to help providers protect their revenues while improving patient health outcomes. Their objective is simple—stop the waste of resources and lives by predicting and stopping losses before they ever happen. Jvion is distinguished in the industry for their leadership in the area of healthcare predictive analytics including their most recent recognition from AHIMA as the 2014 Innovator of the Year.
ICD (International Classification of Diseases) is the code set used to report medical diagnosis and procedures. It is used by healthcare providers to communicate what was done to you and why to your insurance. And it is how an insurance company determines the reimbursement amount to send back to your healthcare provider. We are currently on version 9 (ICD-9) and are moving to 10 (ICD-10). Here in the U.S., we are late to the ICD-10 game. In fact every major developed nation already uses the code set. ICD-9 is more than 30 years old, includes outdated terms, and is inconsistent with current medical practices. Moreover, it cannot accommodate newly developed diagnoses and procedures, innovations in technology and treatment, performance-based payment systems, and more accurate billing requirements. Everyone covered by HIPAA must use ICD-10 starting October 1, 2014. This includes health care providers and insurers who do not deal with Medicare claims. Only workers comp is excluded from the transition. In total, ICD-10 adds up to an $8B challenge for the industry. Every system, coder, physician, and insurance company that deals with ICD-9 will have to convert. And if this conversion isn't done correctly, providers stand to lose millions to reduced reimbursements and extended A/R cycle times.