Analytics - Are you ready for ICD-10 on October 1, 2014?

Identifying ICD-10's Exact Financial Impact - What do you need to know?


There are five times as many codes in ICD-10 as in the ICD-9 code set.ICD-9-CM has 13,000 diagnostic codes whereby ICD-10 has 68,000 diagnostic codes. The specificity to code properly will require on average a physician approximately 20% more time with each patient to capture the required data for accurate billing.   

ICD-9 currently has 3,000 procedures codes, whereas ICD-10 has 87,000 procedure codes. While we code in ICD-9 using a five digit sequence with possibly a single alpha-numeric character, ICD-10 uses 7 alpha-numeric characters.So don't look at it as 2 extra characters because each of those characters can take on 26 other forms. We are talking about an order of magnitude in change (29 times) greater than previously required. Even the most skilled and accomplished billers and coders will struggle with this transition without the appropriate guidance and tools. Prevalent is the best investment against the potential catastrophic financial consequences causes by this transition.

Understanding Your Risk Is the Only Way to Avoid It

Prevalent is one of the leading ICD-10 financial risk analysis solutions on the market and a top choice for providers. Our solution provides encounter-level analytics enabled through our proprietary platform. The powerful predictive modeling capabilities that underlie Prevalent enable the most robust, detailed, and tailored view into ICD-10’s potential negative and positive revenue impacts.

Prevalent has assisted providers from across the healthcare industry landscape address ICD-10’s reimbursement impact and drive a revenue neutral conversion. This module is the ‘core’ of our ICD analysis solution; the results from its risk assessment inform all the remaining solution components including crosswalk development, system remediation, clinical documentation, dual coding, testing, training and even post go-live operational reimbursement monitoring.

The Prevalent process begins with an analysis of 12-36 month’s historical claims data. In two to four weeks for a typical hospital, Prevalent identifies key patterns consistent with negative and positive reimbursement variance. From these key patterns, we prioritize efforts across the organization, from the broad system level down to the departments, coders, physicians, and payors associated with high risk and high opportunity codes. This is where the true value of Prevalent is realized. By allowing your organization to focus on the highest risk areas and automate the lower risk areas of your conversion, your organization will remain revenue focused and efficient throughout the process.

Through Prevalent, you will understand:

  • Which physicians and coders are associated with high risk codes

  • Where to focus documentation and training efforts

  • The specific areas where backfill resources are needed

  • The systems and interfaces associated with high business risk

  • The outpatient and professional fee specialties at highest risk of denials and extended AR cycles

  • Potential reimbursement impacts to a specific line of business

  • The ICD-9 codes that have the highest probability of medical necessity triggers

  • Where in ICD-10 you have the largest probability of RAC audits and additional documentation requests

  • How to best align your testing strategy to financial risk areas

  • Where there are opportunities for business process improvement based on business impact

  • And most importantly, what you can do today to mitigate your ICD-10 financial risk

Prevalent - Delivering the Best ICD-10 Risk Analytics
Prevalent's solution is the most comprehensive and granular financial analysis tool available on the market. This is because we are able to pin-point ICD-10’s exact financial impact by department/specialty, DRG, MDC, procedure code, diagnosis code, physician, and coder. Through this solution, providers receive a historical claims analysis that reflects their unique case mix and business model. It is completely tailored, drives risk mitigation through actionable recommendations, and better aligns to strategic and operational priorities.

Many vendors will claim that they can provide granular financial risk assessment analytics. However, looking out into the market, most of these solutions fall short. They are limited to DRG-level analysis; are not software-enabled or are limited in the amount of automation that they incorporate; and do not provide the level of actionable information that drives real risk mitigation.

The solution that Prevalent delivers:

  • Delivers financial risk down to the code level—this bottom up approach provides the most comprehensive and actionable analytics
    Provides an intuitive and customizable reporting interface so that providers can quickly and easily see the specific financial and operational risk data needed to run the business

  • Provides an integrated solution to ensure that the financial risk is addressed through every part of remediation, testing, training, and post go-live

  • Leverages Prevalent’s financial risk assessment benchmarks to help providers understand their financial risk profile relative to that of other organizations

  • Delivers training recommendations at the coder and physician level, and can integrate with established, recognized training solutions
    Enables more focused chart review and a platform to monitor documentation practices in both ICD-9 and ICD-10









Prevalent, Inc. a subsidiary of Axcension, Inc.

For more information or to see a demo of our product please contact us today.

23537 Kingsland Blvd Suite 124, Katy, TX 77494    l    (832) 413-5990  contactus (@)




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