Outpatient claims have been viewed by many as an area unscathed by the impacts of ICD-10. However, this misconception puts clinics and hospitals at significant risk of increased denials and AR impacts. Even though outpatient organizations file claims against an entirely different code set— all diagnoses will have to be reported against ICD-10. Payors will use the new diagnosis codes to assess the validity of a claim. So, while ICD-10’s impact is less direct in an outpatient setting, there is still an increased risk of denials and negative reimbursement variations once all outpatient claims are required to report against the ICD-10 diagnosis codes.
To address this risk, we bring icdcomplete—a cloud-based, comprehensive software suite that enables the entire ICD-10 remediation process, addresses financial risks in outpatient settings, and helps ensure revenue neutrality.It delivers:
- A full assessment of ICD-10 impacts to resources, operations, and systems
- A view of potential DRG, Case Mix Index, and procedure code reimbursement variations based on historical claims data
- A coding analysis to help accelerate training efforts and identify gaps in documentation
- A complete implementation and testing approach that accounts for all vendor, internal, and external dependencies
- Advanced IT capabilities including enterprise crosswalks, automated system scans for ICD impacts, and system neutralizer
- Project management tools including detailed reports and project dashboards
ICD-10 Financial Risk Assessment
Outpatient providers including physician practices and clinics are, on the whole, behind their acute care peers in assessing ICD-10 financial risk. This is in part because the perception is that ICD-10 won’t impact outpatient settings to the extent that it will impact inpatient providers. While this is partially true, the conversion still poses significant risk to reimbursements regardless of provider type.
To help physician practices, clinics, and all ambulatory settings, Jvion developed our RevCore solution. Through this Big Data analytics tool, we deliver a 2-4 week analysis of historical claims data to provide an accurate view into the codes, departments, and physicians that pose the highest risk to reimbursements.Using RevCore and the powerful functionality within icdcomplete we help reduce financial risk while delivering:
- A listing of highest risk codes, departments, and physicians by potential revenue impacts
- Recommendations on where you need to focus your physician/coder training and education efforts
- A plan for how many backfill resources you will need
- Recommendations on what you can do today in ICD-9 to mitigate your ICD-10
Through RevCore, our outpatient clients have been able to optimize their revenues in ICD-9 and drive revenue neutrality into their ICD-10 conversion.
ICD-10 Conversion Services
Leveraging the full capabilities of the icdcomplete software suite can reduce conversion budget and timeline by 30-50%. icdcomplete addresses the technical complexity of the ICD-10 code conversion so that you can focus on getting the most out of the new code set.
The Complete icdcomplete:Having a software-enabled approach means that we can deliver solutions, recommendations, and services faster and with fewer resources while helping to achieve a revenue neutral conversion:
- RevCore – ICD-10 financial risk assessment tool that provides encounter-level analytics enabled through the Bonobo Big Data Platform ™
- RevAssure - ICD-10 assessment and conversion support tool
- RevIT - ICD-10 system remediation solution that increases automation and enables better IT alignment to business needs
- RevWalk - ICD-10 crosswalk development solution
- RevTest – ICD-10 testing solution
- RevTrend - ICD-10 robust batch/real time, operational analytic solution