Jim Riley, president and CEO, Capario o
Three ways to keep your bottom line in check As the ever-looming ICD-10 deadline continues to draw
near, providers should have an ICD-10-capable billing system in place and be versed in how to successfully operate the system. While many providers have been focused on simply getting up and running, there’s a constant underlining concern around how ICD-10 is going to aff ect the revenue cycle. ICD-10 is certainly not going to cause the next apocalypse,
but providers should be aware that there may be some close calls when it comes to having excess funds during the fi rst few months after compliance. T ere may be delays – even signifi cant ones – to reimbursement, so it’s important to have access to additional dollars in case providers need to off set any temporary interruption in cash fl ow. T at being said, here are three other ways providers can keep
an eye on their bottom line to ensure numbers are in check as ICD-10 compliance approaches: 1. Test, test and test. Don’t let the fi rst time your practice puts ICD-10 to use be after the compliance deadline. Providers must work with their billing system, clear- inghouse and payers to test common procedures and diagnosis combinations for their practice, starting six months prior to go-live.
2. Use analytics tools. After the go-live of ICD-10, ac- cess to tools that provide reimbursement trend alerts – categorized by payer, provider and biller – enables providers to pinpoint bottlenecks in the claims cycle and other concerns. T is level of insight will be criti- cal in eliminating negative patterns and maintaining steady reimbursement.
3. Meet internally every day. Meet with the team – any- one that touches claims processing, ICD-10 coding, etc. – to identify issues so that they can be addressed quickly. While particularly important to meet on a daily basis once ICD-10 compliance starts, it’s also a good idea to meet periodically leading up to the transi- tion to iron out issues along the way. While ICD-10 will aff ect everyone diff erently, reimburse- ment doesn’t have to be a concern. Testing, analyzing and planning as an organization can remove much of the headache from the process and help organizations rest assured their bot- tom line is secure transitioning to ICD-10.
Michael Najera, VP, professional services, Craneware
Best practices for clean claims
All hospital claims contain charge data. Charge data is stored in the organization’s chargemaster. With increased focus on hospital pricing and charging, and the Department of Health
and Human Services (HHS) open data initiative’s release of hospital chargemaster data to the public, best practices to ensure charge data accuracy and transparency throughout the organization are critical.
Clinical leaders may not be as familiar with the revenue cycle and changing payer requirements. Without a reliable process to validate that charge capture is complete and charge data is correct, missed charges and coding issues present signifi cant risk and can cost hundreds of thousands of dollars. Charge- master management is essential to mitigating revenue leakage, audit and compliance issues. Best practices for chargemaster accuracy include: • Compare chargemaster data against Centers for Medicare & Medicaid Services (CMS) rules.
• Develop a team to verify charge data, including represen- tation from all departments that create the medical record and that capture and account for services provided.
• Review with this team the charge data to ensure it is current, while identifying issues and barriers to charge capture improvement.
Support this team with tools enabling: • A system-wide view of chargemaster data across business and clinical stakeholders with department-specifi c views.
• Automated workfl ow to assign, track and measure ac- countability.
• Easy access to information that answers questions on payer requirements.
• Prioritization of ongoing issues that are roadblocks to achieving optimal fi nancial performance.
• T e use of chargemaster data and the team’s fi ndings to educate staff throughout the organization about the requirements for eff ective documentation.
With data in hand, leaders can identify and prioritize ongo- ing issues that are roadblocks to achieving optimal fi nancial performance.
Deepak Sadagopan, GM, clinical solutions and provider segment, Edifecs
Critical steps to catching up For provider organizations behind in the transition or not
yet started, ICD-10 could be a nightmare. According to a recent report, 33 percent of providers haven’t started, and 22 percent don’t know where to begin. CMA and AHIMA have provided some resources, but with 12 months remaining, the time to act is now.
ICD-10 dramatically increases the number of codes, changes coding scheme structure and introduces clinical con- cepts, terminology and granularity, impacting every aspect of healthcare business. Some provider organizations hope for a deadline extension, while others don’t have enough resources to manage the transition.
Analyzing mountains of historical data to understand the ideal mapping between code sets can be complex due to a lack of a one-to-one relationship. However, organizations can mitigate this issue by identifying and prioritizing high-risk codes based on frequency of use, complexity of the mapping relationship and fi nancial impact.
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