Don’t Let the Transition to ICD-10 “Stall Out” Your Revenue Cycle!

One of the worst things that can happen to an airplane pilot is to suffer a stall; that means — more than likely — a crash is imminent. Without proper planning, your revenue cycle is headed for a stall after the October 1, 2014 ICD-10 transition deadline. It’s critical that you devise a strategy NOW to avoid an ICD-10 claims backlog and a deadly stall for your accounts receivable.

The Centers for Medicare & Medicaid Services (CMS) has recommended that hospitals begin planning immediately for ICD-10, but so far, CMS reports many hospitals have not heeded their recommendation. This mistake can ultimately cause serious damage to hospitals’ revenue streams. CMS has also found in addition to having no transition plan in place, many hospitals have not begun any ICD-10 training, or work on their documentation improvement processes — both of these activities are critical to the success of dealing with the new coding system.

Also according to  CMS, many healthcare providers have not even begun to consider the greatest threat to their facility’s revenue stream — severe reductions to reimbursements caused by insurance claims backlogs. The increased granularity of the new ICD-10 coding system, which consists of almost 70,000 diagnosis codes as well as well over 72,000 procedural codes, will create the opportunity for potential errors in coding workflows and produce a tremendous backlog of claims. Even the most experienced coders are going to find this transition challenging.  CMS opined again in early September that hospitals should begin their planning process today. And, that effort should begin with a documented transition plan.

Here are our recommendations for creating a viable ICD-10 transition plan. Your plan should include an ICD-10 readiness review. ICD-10 will mandate a huge change in your entire organization.  To deal with this change management, select a key person within your organization to be in charge of your ICD-10 transition project. This person’s responsibility will be to monitor all changes that will inevitably occur before and after the October 1, 2014 deadline, and report these activities to the rest of your staff. This individual will also be responsible for engaging key stakeholders to convince them ICD-10 compliance is critical to the financial health of your organization, and to ensure there is “a sense of urgency” within your organization to drive the necessary changes forward.

  1.        Understand how ICD-10 will impact your organization, enterprise-wide.

Your plan should include a gap assessment and analyses.  A gap assessment will help you gain an understanding of where and how ICD-10 will impact your organization. The assessment should include your people and their present expertise, your business processes and your legacy technologies to determine the impact of ICD-10, enterprise-wide. Any aspect of your organization that will be impacted by the ICD-10 transition should be carefully examined, including the programs and systems you are presently using for claims processing, analytics fraud detection, enrollment, eligibility and benefits. This gap assessment will let you know where you need to make proactive critical process changes before the deadline falls and your revenue is impacted.

2.           Take advantage of educational opportunities.

Specialty associations, such as AHIMA, AMA, MGMA, HIMSS and several billing associations will be offering training programs and information. Take advantage of these opportunities. Every organization is going to need some kind of training. The AAPC, a medical coding training and education association, expects that training will take about 50 hours for inpatient coders. People coding hospital charts will need to know both inpatient and diagnostic codes. The learning curve is going to be tremendous. E-learning programs that contain bite-size, easy to digest lesson presentations that your staff members can access any place they have Internet availability will have the least impact on their daily productivity. Industry webinars sponsored by various associations will focus on specific aspects of the ICD-10 transition. Monitor the topics of these webinars and ensure your staff members attend the appropriate ones.

Even after using good training programs, there will still likely be a backlog of claims. Your coders will be working more slowly because they are less familiar with the system. There is also an expectation, at least initially, that there will be more denials, which will take time to recode. You may want to consider enlisting outside help from expert sources who have been training for years to meet the challenges of ICD-10. They can help with your coding backlog and denial management.

Another educational exercise to consider is to identify and evaluate — in advance of the ICD-10 deadline — the potential high-risk codes and claims that will most likely have an impact on your specific revenue stream. These simulated ICD-10 claims can provide important data, enabling you to make critical financial analyses to your revenue stream before your coders ever begin working with ICD-10.  Conduct several tests on your simulated claims with your payers. Find out if they were accepted or denied. This information will allow you to proactively make needed changes within your organization to help ensure your financial well-being and stability during the transition.

3.            Enlist technology to help with your transition

Finally, don’t try to do everything on your own. Enlist technology to help you mitigate your financial risks. Technology is available today in the form of computer-assisted coding (CAC) tools.  CAC is a proven technology that automatically derives and assigns medical codes from within clinical documentation. Many are ICD-10-ready.

With this technology, your organization can “hit the ground running” and streamline your revenue cycle processes, while becoming increasingly more compliant with payer requirements and quality reporting. Some of the CAC technology vendors offer on-site coding expertise to ensure there is no lag in your coding workload. These technology solutions can work with your electronic health record (EHR) and financial systems to produce extremely accurate coding.

The benefits of CAC are many and you are going to need all the help you can get during this challenging time. These systems do not replace your professional coders; they just aid them and ensure improved accuracy, compliance, productivity and consistency, while your facility is “getting up to speed” on the new ICD-10 codes. This approach will alleviate the negative financial effects that will come from the October 2014 “hard cut over” deadline to the new system.

4.            Preventing Claims Backlogs Will Mitigate Your Financial Risk

The ICD-10 transition will have a tremendous impact on your organization and its revenue stream, and this impact will be felt for years after the ICD-10 migration has begun. Having a documented plan in place that will help you understand the impact on your revenue stream will go a long way toward mitigating any negative impacts. Taking advantage of the available educational programs will help you manage the ICD-10 transition and ensure the risk remediation programs you put in place can be maintained over time to mitigate future impacts to your revenue stream.  Finally, utilizing  a CAC tool, together with onsite coding assistance, will ensure your reimbursements and your revenue stream  survive the ICD-10 transition without experiencing a deadly stall.