Addressing Financial Risk—Inpatient Provider
- Following a 5010 conversation that created revenue cycle and claims processing challenges, this 300-bed not-for-profit hospital in the Southeast wanted to proactively address possible ICD-10 conversion impacts
- Using Jvion’s RevCore solution, we:
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- Collected one-year’s worth of historical data (current ICD-9 reimbursements equaled around $161 M)
- Simulated reimbursements against 23,000 claims using RevCore
- Developed detailed analysis and impact reports
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- Determined that the average reduction in reimbursement following the conversion to ICD-10 equaled 5.1% or $8.2M
- Identified six MDCs that impacted 80% of revenue and determined that three of them had a potential negative impact of $6.2M when converted to ICD-10
- Identified eight DRGs that will result in a potential savings of greater than $5M when converted to ICD-10
- Determined that three physicians were primarily responsible for the eight highest
impact DRGs being assigned to claims, which helped prioritize ICD-10 training and
education efforts - Identified the 20 principal diagnosis codes causing a $4.8M negative impact in
current revenues - Identified opportunities to move away from unspecified coding in ICD-9 and developed
revenue neutral crosswalks to avoid negative reimbursement impacts when
converted to ICD-10
