ICD-10 Risk: How medical practices can protect their revenue cycles

Carl Natale
by Carl Natale

It's no secret that ICD-10 implementation could hurt a medical practice's revenue cycle worse than walking into a lamppost.

But it doesn't mean that a medical practice has to assume it will lose money.  That's why I want to review Denise Junkin's useful post on ICD-10: how to evaluate the impact of ICD-10 coding on a medical practice's revenue cycle. It has some useful warnings and advice.

Decreased productivity

Conventional wisdom says the increase in diagnosis codes and complexity of procedure coding will cause medical coders to process fewer medical claims. But medical practices can prepare to lessen the impact of ICD-10 coding on productivity:

  • Measure productivity now.
  • Practice ICD-10 coding on real medical records.
  • Hiring coding help will keep medical claim processing moving.
  • Focusing specific coders on specialties should increase productivity.
  • Clean up the  discharged not final billed (DNFB) so it's not slowing down medical coders trying to get a handle on ICD-10 codes.
  • Automation can boost efficiency and productivity if is done right.
  • Prepare management for the loss of productivity.
  • Schedule testing with healthcare payers.

Interrupted cash flow

There are too many things that could prevent health plans from reimbursing medical claims in a timely manner. They could have system meltdowns or drastically change policies. Prepare a post ICD-10 implementation survival strategy that includes:

  • Money spent on training and education is an investment in medical coding productivity and accuracy.
  • Clear out reimbursement backlogs now.
  • Boost productivity now (see above).
  • Testing with healthcare payers will give providers an idea of how reimbursements may change.
  • Measure denials, rejections and the time a claim takes to pay (more below).
  • Cultivate relationships at your major health plans.

Incompatible systems

Start talking with healthcare vendors to see what they plan to upgrade and what is covered. Then test your new systems:

  • Identify testing entities.
  • Determine what needs to be tested.
  • Engage in a dialogue with each entity to identify specific, relevant testing needs. S
  • Schedule testing.
  • Troubleshoot problems.
  • Document all test scenarios.

Increased volumes of work

Prepare for an increase in medical claim denials from healthcare payers after Oct. 1, 2015:

  • Assign a point person to communicate with healthcare payers when ICD-10 claims are rejected or denied.
  • Identify trends in denials.
  • Consider hiring new staff or consultants to manage denials.

Incorrect mappings

Take time to understand the limitations of mapping tools and how they should be used.

  • Understand how payers will apply general equivalency mappings (GEMs) and DRGs.
  • Verify mapped codes.
  • Better yet, don't use MAPs to create ICD-10 codes.

Increased risk of payer audits

Things are going to get tricky. In addition to the likelihood of increased claim rejections and denials, there will be new criteria for audits. Beware of:

  • Unspecified codes.
  • How well diagnoses on claims match clinical detail.
  • New payer policies and procedures.

Much of this can be mitigated by communicating with healthcare payers.

The economics of ICD-10 coding will be a challenge but it doesn't have to kill medical practices.