How ICD-10 will impact your revenue cycle management

revenue cycle management
April 17, 2013

Posted by MedbillingExperts / 0 Comment

In October of 2014, the transition into ICD-10 for the United States will begin. At this point it will also be divided into two separate systems. The first is ICD-10 Clinical Modifications (with over 68,000 diagnostic codes and many more categories than ICD-9-CM) and ICD-10 procedure coding (which is for inpatient hospital coding for procedures). So, what does this mean for business? A lot of changes, since this is considered a significant overhaul in the coding system.

Increased Code Numbers

The biggest change will be the increase in codes, since the system will be going from 17,000 codes to 140,000 codes. This will require enhanced ability on the part of the coding specialist to accurately break down the procedure and link it to the proper code. This may require increased training or even the hiring of experienced billing specialists. It is likely that some firms will need to bring a Revenue Cycle Management Partner professional on-board so that the transition to the new system is as seamless as possible. The best way to prepare for the transition is to prepare the staff for the transition. Since the final date for implementation is still relatively far away, there’s a lot of opportunity for provider officers to begin training staff and moving them through practice well in advance of the necessary date, which will cut down on initial obstacles. There is a fear among some professionals that demand will quickly outpace supply, leading to increased reliance on outsourcing in order to meet business needs.

Experienced billing professionals will greatly aid in the success of companies transiting to ICD-10

Process Operation and Accurate Service Reflection

In this transition, healthcare providers must conclude whether there’s an opportunity here to improve processing to accurately reflect provided services. Since ICD-10 will allow for increased data inflow to the office, this data could be analyzed to better streamline workflow and develop decisions drawn from the data.

Careful evaluation of data may offer the opportunity to maximize the revenues cycle

Reconfiguration and Updates

Eligibility, as well as utilization management, will need to be reconsidered in light of the changes coming through ICD-10. Other updates include medical necessary and policy checks. A full evaluation of protocols should be assessed to examine possible changes and adjust as needed in order for effective implementation.

It might be time for new procedures and protocol developments, which must be communicated to all staff accordingly.

Preparing for Mistakes

If mistakes in medical billing are already part of your business, this is likely to get worse during the transition to ICD-10. There is a steep learning curve associated with the increases in coding and new requirements could result in employee frustration and increased pressure on the part of healthcare providers. Processing could take more time and fixing mistakes can also be very time-consuming. Use these mistakes as training opportunities to ensure that all staff are on the same page. Accepting that these mistakes will happen and using them as chances to improve are the only way to move towards long term success.

Expect mistakes, but develop a plan for managing them.

Testing Preparations

Coding transitions between ICD-9 and ICD-10 will not be exact, so it’s possible that mismatches will cause problems for reimbursement. Total end-to-end testing will be necessary to verify that all information is compliant and to reduce the overall impact for reimbursement. This could take time, but unfortunately that is the cost of improved business and better analytics that can help to improve your bottom line.

Identifying issues early on will reduce the numbers and effects of reimbursement challenges faced.

The more your office is prepared for the implementation of ICD-10, the fewer growing pains you’ll experience on the dates surrounding the commencement. Plan in advance and keep employees in the loop to see success.

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