Mitigating risks associated with ICD-10

ICD-10 compliance no guarantee of success

While most hospitals and health systems will “make it over the finish line” to submit ICD-10-based claims starting Oct. 1, 2015, simply complying with the mandate will put millions of dollars at risk. For example:

  • Failing to adequately engage and train physicians on key ICD-10 documentation concepts will make accurate coding difficult and lead to underbilling and underpayments.
  • Neglecting to identify and address potential changes in DRG structure and payer crosswalk decisions could shift reimbursement, even if patient mix and documentation specificity stay constant.

ICD-10 Compass predicts and monitors ICD-10 risks and impact

Our business intelligence technology helps hospitals and health systems safeguard revenue by identifying pre- and post-transition ICD-10 risks, making root-cause analyses and risk mitigation efforts straightforward and transparent.

Key components of the business intelligence technology:

  • ICD-9/ICD-10 translation tool, incorporating CMS general equivalence mapping crosswalks and proprietary standard or custom mapping scenarios
  • Tailored prioritization guidance, such as identifying high-volume or high-revenue codes that require significant documentation specificity
  • Predictive and actual analytics, such as DRG reimbursement impact
  • Benchmarks and drill-down analytics to identify and manage under- and over-coding risk
  • Coder and physician performance analytics to hardwire performance improvement

In addition, our dedicated advisors work closely with members to analyze problem areas, prioritize improvement opportunities, and share peer organizations’ best practices.

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