As the ICD-10 implementation deadline draws closer, according to the Centers for Medicare and Medicaid Services (CMS) you and your administrative staff should have:
- Finished your needs assessments and be finalizing your coding training and software installation
- Completed the Impact Analysis and
- Prioritized remediation to be undertaken, and be preparing to put the remediated systems into test mode.
For a smoother transition, all the above steps need to be taken before the final, critical step of monitoring and controlling the performance and transaction flow across all enterprise systems.
While your practice’s goal should be to sustain and eventually increase revenues from correctly-coded information using the new ICD-10 coding, in the short term, your early results will likely be the minimizing of financial risk. By performing Integration Testing on the systems before releasing them into full production, you can reduce expensive errors and future billing headaches.
Monitoring and control integration
When monitoring, you will be assessing the impact upon reimbursement rates, denied or rejected claims, as well as accuracy and productivity performance rates.
Revenue cycle impact
You need to track the results of your reimbursement rates, including samples of ‘high-risk’ codes, and analyzing rates of reimbursement to determine whether there are any discrepancies and problems with payers and other trading partners, as well as determine their impact on revenue cycles. To do so, you will need a Transaction Management system capable of:
- Utilizing revenue cycle key performance measures and
- Generating real-time reports to identify ICD-10 issues with remediation.
- If discrepancies are noted in the reports, you will need to take the necessary steps using your risk management or other contingency plans to reduce and control any adverse effect to your practice.
- Be willing to work closely with your payers on reimbursement problems and issues as well as ICD-10 readiness.
According to information from Health Information and Management Systems Society (HIMSS) classifying and basing revenue cycles based on chronic condition categories allows for a better picture of revenue impact, especially when compared to historical data of reimbursements for chronic conditions.
Be alert for any ongoing changes in your Resource and Patient Management System software as well as general system updates, which can affect coding accuracy.
Accuracy and productivity in personnel
No monitoring plan or system is complete without a means to monitor the accuracy as well as the productive output of coders and billers, as well as health records personnel. The Indian Health Service (HIS) offers these guidelines:
- All training should be completed well before the deadline to ensure that personnel have the knowledge and have gained some level of experience, especially with coding and billing high-risk and chronic conditions, to minimize the risk of mistakes or omissions.
- If you find that some errors or discrepancies are due to coding mistakes, retraining may be necessary.
- Be sure that new coding and billing staff are provided training.
- Monitor improvements in your clinical documentation, as these will affect the accuracy of the coding as well as productivity.
- Pay attention for signs of stress shown in coders and other billing staff while undergoing training.
The end result of all of the above steps, especially how closely and accurately you monitor, will be faster reimbursement, fewer denied claims, and higher revenues.
For more information about the transition to the ICD-10 coding system, as well as any coding, billing or documentation concerns, contact M-Scribe Technologies, LLC, a leader in medical billing, coding and documenting. Talk with their experienced personnel and earn how M-Scribe can help your practice achieve optimum revenues through best-practices for optimum efficiency and compliance.