How to protect revenue during ICD-10 implementation
The “Increasing Clarity for Doctors by Transitioning Effectively Now Act” is an attempt to create a 'safe harbor' for medical claim reimbursements for physician practices struggling to get ICD-10 coding correct.
Physicians are afraid that because they will be forced to use a complicated coding system, they will make mistakes that trigger reimbursement denials. This could drastically reduce their cash flow to the point that it endangers medical practices.
Some experts advise healthcare providers to secure lines of credit or have enough cash reserves to keep the practice running for six months. Which really isn't that feasible for many medical practices. This will come after they invest in equipment upgrades and staff training.
But there are other things they can do to revenue after Oct. 1:
- Invest in training and education: A thoroughly prepared staff will enjoy higher medical coding productivity and accuracy. This is a good way to keep medical claims going out the door with fewer coding errors. That means more revenue coming back.
- Analyze the most used diagnoses: That's where medical practices stand to lose the most money. So understand how to properly assign ICD-10 codes and how much reimbursements could change.
- Tighten the reimbursement cycle: Clearing out reimbursement backlogs now will make more money available before it is needed.
- Boost productivity: This will strengthen the physician practice finances and give productivity some room to drop after Oct. 1.
- Test with healthcare payers ASAP: Find out if the ICD-10 upgrades work like they should, any shift in reimbursement policies.
- Take a financial snapshot: Measure denials, rejections and the time a claim takes to pay. This will help understand what is going wrong Oct. 1 and how to prepare for interrupted cash flows.
- Keep some ICD-9 code books: Yes it is federal law that all HIPAA covered entities must use ICD-10 codes after Oct. 1. But what are you going to do if a non-covered payer asks for ICD-9 claims? Be ready to send ICD-9 claims just in case.
- Make new friends: Get friendly with someone at your major health plans before everyone else wants to be their friends. Medical practices want someone to take their calls when every medical practice, hospital and clearinghouse is asking for the status on overdue reimbursements.
These aren't the easiest steps to take. But they don't rely on Congress or the Centers for Medicare and Medicaid Services (CMS) creating "safe harbors" for denied reimbursement revenue.