Maintaining Positive Cash Flow in the Midst of the ICD-10 Transition
DOCUMENTATION
Dr. Steven J. Kraus
The transition to ICD-10 has represented significant challenges for many providers-from significant time focused on paperwork and processes to dealing with delayed or denied claims. Nothing quite gets the attention of a squeaky wheel when that wheel is cash flow. Protecting your practice—and your profits—has quickly become paramount in the midst of such a radical change in coding standards, and having a clear game plan is critical for returning to a positive cash flow. Prior to the transition, experts warned that productivity and profits would be the two factors most affected during the ICD-10 transition period, and now that we’re in a post-ICD-9 world, focusing on both must be top of mind.
According to a recent study published in Perspectives in Health Information Management on the subject of the move from ICD-9 to ICD-10 coding, “The prevailing estimate of productivity loss is typically somewhere between 30 and 50 percent.” Some results came in even higher, citing that coding is expected to take anywhere from 54 to 69% longer. These are sobering statistics for any provider who now finds that reality and estimates are closely aligned, especially if you perform all of your billing tasks.
While productivity takes a bite out of the financial picture, some practices are finding that denial rates make a substantial dent as well. Just prior to the transition, the Centers for Medicare and Medicaid Services (CMS) estimated that denial rates would surge and rise by as much as 200% in the early stages of the ICD-10 implementation.
This means that providers need to have the funds available up front to carry their practices through lean times. If the transition results in plunging reimbursements for your practice, you’ll still need to cover staff salaries and rent to keep the office doors open. Some providers heeded the urging of the American Medical Association (AMA) to set up a line of credit and start saving months before the transition, but, in reality, most did not have the means to do so. A chiropractic practice will more likely see less of an impact than a medical practice. Even if a practice is excellently prepared and codes correctly, though, there aie issues on the payer side in the form of cash flow disruptions that could further delay payments.
In the midst of all that is currently weighing down the ICD-10 transition, there’s good news. It doesn’t have to be so difficult. For those who do find themselves and their practices suffering from ICD-10 issues, you can take some steps to immediately to reverse the situation. The sooner you implement these, the sooner you can get back to doing what you do best—helping your patients find health.
1. Employ a Supportive EHR System
Your EHR system is the cornerstone for the health and growth of your practice. To properly manage your business through tough times (you know, like a complete upset of your traditional code set), you need a system that has taken care of these challenges ahead of time. If your EHR system did not
actively advise you prior to the transition about how they planned to help you navigate the new choppy coding waters, then it’s time to find a vendor with a plan that can still be implemented now that the transition has taken place. Look for the following support system in an ideal EHR vendor:
• ICD-10 Implementation Tools
Tools such as ICD-10 wizards should help you quickly navigate the ICD-10 transition by offering an easier way to migrate codes and instantly access each code set. Look for vendors with tools that can:
0 Index codes and search for diagnostic terms and conditions.
0 Edit individual payer information for ICD-10.
0 Easily categorize codes by laterality, condition, and anatomical location to help you quickly and easily choose the most appropriate code.
• Consultation with Industry Experts
Your EHR vendor should be well connected across the country and should be inviting industry experts into their development discussions to help determine the most applicable and common ICD-10 codes used by their clients.
• Ongoing Support Services
Look for robust support services and supporting documentation that can help you get the most out of your software, along with an online community forum where you can interact with fellow users and share tips and tricks along the way.
Your EHR system should be backed by an industry name you can trust and one in which you can place your full confidence. With ICD-10 raining challenges on your practice, your EHR provider should be holding out an all-encompassing umbrella.
2. Consider Outsourcing Your Revenue Cycle Management (RCM)
Maybe it’s time to consider taking a load off and assigning your billing tasks, posting and accounts receivable management, to the experts. By outsourcing your RCM, you can increase your collections and retain precious revenue throughout these trying times. Protecting your cash
flow and keeping your claims from declining into a tidal wave of denials can help you keep those reimbursement checks coming. Getting on board with an outsourcing company is integral if you want to avoid the projected rate hikes that may hit as the ICD-10 implementation increases the demand for such services.
Outsourcing can reduce expenses, improve collections, provide better practice analytics, offer more consistent results, reduce errors, and minimize disruption. With less time focused on your billing, you’ll have more time to focus on the patient-centric aspects of your practice.
3. Train Your Staff
With roughly 50,000 more codes than the ICD-9 code set, there is more to this transition than a simple one-to-one mapping. Training your staff is imperative for a smoother ride through this initial period of conversion. If you haven’t already, implement an education plan that can help you reduce loss of productivity, increase the accuracy of claims, and get your practice’s cash flow back in the black. In addition, your staff will gain morale benefits when they feel empowered with knowledge and more secure knowing that you are all in it together.
It’s easy to understand why many practices didn’t focus on ICD-10 prior to the transition because it had already been delayed several times. Now that it’s here and potentially causing issues for your practice, it doesn’t mean you can’t ramp up quickly and get your practice back in order. With the right vendor on deck, a proper training schedule, and outsourced revenue cycle management, you can put the brakes on the mammoth toll ICD-10 may have on your practice.
References:
1. http://www.oncologynurseadvisor.com/web-exclusives/transition-toicd-10-may-cause-loss-of-infonnation-and-revenue-for-health-careprofessionals/article/341817/
2. http://www.beckersasc.com/asc-coding-billing-and-collections/5-stepsto-prepare-for-icd-10-starting-now.html
3. http://www.icdl0watch.com/blog/icd-10-testing-scenarios-what-medicalpractices -need-know
4. http ://www.nationalascbilling. com/Thought+Leadership/Are+You+Read y+Productivity+Cash+Flow+to+be+Hardest+Hit+by+ICD+10
5. http://perspectives.ahima.org/preparing-for-icd-10-cmpcs-implementation-impact-on-productivity-and-quality/#.VgNIwRHBzGc
6. http://www.aihc-assn.Org/Portals/3/ICD-10%20HiMSS%20Risk%20 Mitigation.pdf
7. http://www.himss.org/News/NewsDetail.aspx?ItemNumber=27474
8. http://medicaleconomics.modemmedicine.com/medical-economics/RC/ claim-denials/claim-denials-15-ways-fight-back?page=full
â,Steven J. Kraus, DC, FIACN, DIBCN, FASA, FICC, is the chief market strategy officer for ChiroTouch, the nation ’s #1 provider of chiropractic-specific EHR practice management software. He is an acknowledged expert in health IT, including electronic health records (EHR) and HIPAA issues affecting chiropractic practices and EHR. To learn more about maintaining positive cash flow for your practice from Dr. Kraus, visitwww.ChiroTouch.com TAC.
