8 anti-fraud questions to ask now about ICD-10

1. How reliable is the data that is known, in order to re-map?
2. How do you do trending and peer group analysis over time, and determine claims that are actually quality delivery of care vs. outliers worthy of scrutiny?
3. Are there errors in the mapping, or worse yet, intentional misrepresentation of the facts, by creative billers?
4. Will billers use a combination of ICD-9 and ICD-10 based on what might be more advantageous for their reimbursement, and say “oops” later?
5. Will providers and plans use the ICD-10 opportunity to re-negotiate every contract provision, to the detriment of the other, thereby resulting in added administrative and medical costs?
6. Will fraud alerts really be false positives, because of data integrity issues?
7. Are there holes in the system (edits) that can be corrected while the mapping exercise is underway?
8. Who is at fault for any errors: the payer, the provider, the claims editing vendor, the clearinghouse?

Source: Government Health IT
Source URL: http://www.govhealthit.com/news/8-anti-fraud-questions-ask-n...

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