Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Keep the Cash Coming: Financial Considerations for ICD-10 Implementation

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The October 1, 2015, ICD-10 Implementation is less than a month away. Not ready? You’re not alone.

At the beginning of August, WEDI reported that fewer than half of medical practices say they will be ready for the switch. A survey commissioned by billing and payments solution vendor Navicure and conducted by Porter Research in August revealed an industry expecting the worst for cash flow and revenue cycle management.

According to Healthcare Finance, 94 percent of participants in the Porter Research survey expect more denials as a result of ICD-10, but only 30 percent have taken steps to improve their denial management processes. As many as 35 percent of survey respondents have done nothing to improve their revenue cycle as ICD-10 approaches. Are you in the same boat?

It’s not too late to take specific steps to prepare your bottom line for the transition.

1. Improve your processes for collecting patient payments.

According to Ken Bradley, vice president of strategic planning and regulatory compliance and one of Navicure’s founding members, when denial rates go up, your revenue cycle will benefit by attempting to collect balances from patients and insurance companies at the same time. “By generating patient estimates and requesting payment at time of care rather than waiting for claims payment, providers can substantially accelerate cash flow – and mitigate risks associated with both delays and denials,” Bradley said in a recent ICD-10 Monitor article.

2. Submit ICD-9 claims for dates of service prior to October 1 as soon as possible.

In the weeks immediately after the ICD-10 implementation, coders, billers, payment posters, and AR teams are going to be working with two sets of diagnosis codes and two sets of edit, denial, and payment rules. Request that your physicians finish charting and submit charges for billing as quickly as possible. Reconcile billed charges to physician, hospital, or office scheduling logs as quickly as possible so you can identify any missing charges and get those billed.

3. Make sure your AR is in good shape on October 1.

In these last few weeks before the ICD-10 transition, and even in the first couple of weeks of October, push your billing and follow-up teams to clean up all past and current denials and to collect as much outstanding revenue as possible. Not only will a clean AR position your practice well for the transition, but once ICD-10 claims are processed, your billing team will be operating under multiple sets of rules as they work denials and appeal claims.

4. Be prepared for reduced productivity and ready your staff for increased overtime.

Some experts estimate that productivity for coders will be cut in half, particularly in the first few months after ICD-10 implementation. And that’s to be expected given the new code set and the pressure of going live. Prepare your practice or billing company for this reality by beefing up staff, providing increased training, and planning on overtime in the few weeks following implementation.

5. Don’t be satisfied with low productivity for long.

Begin tracking tasks under the new paradigm of ICD-10 so you can identify and correct any bottle necks. Carl Natale of ICD-10 Watch suggests monitoring the following metrics, moving toward measurable improvement as the entire team adjusts:

  • Time to correctly code a medical claim
  • Time it takes to get a medical claim from patient encounter to transmission to healthcare payer
  • How long it takes for healthcare payers to answer coding questions
  • How long medical claims are in accounts receivable
  • Denial rates and how much money is denied
  • Difference between reimbursements and contracted rates

6. Plan for the worst, and hope for the best.

Some people are whispering “Y2K” in response to the doomsday predictions for ICD-10. They could be right. Things might work out just fine; revenue might keep coming in just as it has. But don’t get caught unprepared if it doesn’t. Secure a line of credit. Bolster your staff for possible long hours and frustrating problems. Continue working with physicians on clinical documentation. Ask your business intelligence team to prepare reports now that will help you identify denial trends and AR opportunities.

Want more information? Review the resources below to help you keep the cash coming.

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com.


Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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