Freed Associates

Managing External Risks Associated with ICD-10: A Framework for Providers and Payers

TOPIC: Denial Management, Health Reform 2.0, Information Technology

With the implementation of ICD-10 in October 2014, we can expect there to be coding errors, reimbursement errors and even providers and payers that are not at all ready for the cutover. This article outlines these risks and articulates a risk management framework that will guide both payers and providers through the ICD-10 transition.

Considering the framework provided within this article, an organization should consider the following three steps:

  1. Create an inventory your external trading partners, sorting by annual dollar volume (high to low).
  2. Reach out to your trading partners and schedule a test of healthcare transactions, e.g., 837 claims and 835 remittances using claims with ICD-10 codes.
  3. Take appropriate steps to insulate your organization by preparing for dual processing and dual coding contingency strategies.