Healthcare News & Insights

Don’t let ICD-10 impede your cash flow: 4 steps to take now

177110055Want to hear something scary? Of 55,000 physicians at 1,200 practices, only 4.8% reported significant progress in overall ICD-10 readiness. The good news for you is that hospitals reported a higher level of readiness, however, many are still lagging behind. 

That’s according to a recent Medical Group Management Association (MGMA) poll.

There is a definite sense of urgency since there are only six months until the ICD-10 deadlines (Oct. 1).

Some experts are even likening the lack of preparation and panic to the concern that surrounded Y2K 14 years ago. While this may be true, ICD-10 has a well defined implementation and readiness process. Y2K was a far more nebulous concept.

Keep revenue streams flowing

While verifying compliance of financial connectivity software is a good way to start ICD-10 compliance, it involves so much more.

In order to protect their revenue streams, hospitals need to focus on a number of different things, such as education, testing and process improvement, noted Joshua Berman, director of ICD-10 at RelayHealth, on Healthcare IT News.

With the final countdown on, Berman suggests hospitals focus on the following four key areas:

1. Test, test and test again

There is no such thing as too much testing when it comes to ICD-10 readiness. However, some payors make this challenging because they either aren’t testing or are testing with a select few providers.

If end-to-end testing isn’t possible, try creating a partnership with the payors you have a good relationship with and test with them as often as you can. And remember, you want to do more than just uploading claims to a portal. You want to send claims through the same channels you would use from start to finish, as if it was already past the deadline.

One thing to keep in mind is the Centers for Medicare & Medicaid Services (CMS) has reversed its original stance on ICD-10 testing. The agency now will offer full end-to-end claims testing for providers, according to a recent article in Keep Up to Date on Primary Care Coding & Reimbursement. CMS will randomly select providers who opt-in as volunteers to participate. Keep your eye on CMS’s website, because info on how facilities can opt-in will be released shortly.

CMS’s testing will process claims from start to finish just like regular claims would be processsed, and facilities will receive remittance advice from CMS after submission.

2. Educate, educate, educate

The difference in the number of new codes that will be in ICD-10 as compared to ICD-9 is staggering. If there is one word to encompass ICD-10 coding, it’s specificity.

ICD-10 coding methodology not only features a significant number of new codes, but there’s an increased complexity in ICD-10 coding.

Therefore, coding staff and physicians must invest a good deal of time in training.

Luckily, there are a number of different training options available from self-paced online and book-based courses to instructor-led classes. However, don’t think you can offer one class and your staff will be trained in one fell swoop. It doesn’t work that way, because there’s just too much to learn.

ICD-10 training is something that needs to be done a little at a time, over a period of months. You have to let the first steps sink in before you move on to the second step.

3. KPIs: Know them, track them

It’s vital that your hospital knows the key performance indicators (KPI) that’ll be affected, such as denials, rejections and release to payment. Find out benchmarks for them and make sure your facility is doing better than the benchmarks on all KPIs.

Your facility needs to evaluate all KPIs for facilities of similar size, region and focus. By having access to KPIs of similar facilities, you’ll be able to improve your KPIs prior to the ICD-10 deadline and be able to judge how you are doing immediately after the deadline goes into affect.

It’ll also give you a more accurate view of what’s working after Oct. 1. Knowing all of this will allow your hospital to make smarter decisions.

4. Think outside the box.

Being positive is great, but this may be one of those times when it’s better to think in terms of “anything that can go wrong, will go wrong.”

Prepare a checklist of everything that could happen and could impact your hospital. Then talk to each and every department it affects, and make sure they have a game plan for how to handle the situation should it occur. This way your hospital will be prepared for anything and everything.

In his article, Berman wrote, “Sharing information and fostering productive relationships between payors and providers can go a long way toward enhancing readiness … We’re all in this together.”

  • Barry Elliot

    Your blog is really interesting. Your given four key
    areas are really awesome. Availity is ready for ICD-10, and has completed system
    updates for its Revenue Cycle Management product to allow ICD-10 in all HIPAA-compliant
    transactions.

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