Before the October 1 deadline, now is good time to do a thorough assessment of your ICD-10 plan and, with many aspects of revenue cycle management (RCM) closely tied to ICS-10, an assessment of your front and back office readiness also now can save you a lot grief and missed revenue during and after implementation.
Assess & Refine the ICD-10 Plan
Are you where you planned to be at this time with ICD-10?
With so many moving parts, it easy to miss an important task or overlook an important piece. To check if your plan has any gaps or missing elements, the CMS offers project plans for you to check against. Example: The Small Physician Practice’s Route to ICD-10.
Are your systems ready for submitting claims with ICD-10 codes? Have they been tested? If not, download CMS Test and Get Ready Now for testing resources.
Identify what needs you attention, adjust priorities and develop contingency plans so as not to impede cash flow. You may consider a healthcare clearinghouse in the end.
Assess & Refine RCM Elements
The elements for RCM needing assessment begin with the front office through to the back office, with the physicians in the middle doing the documentation.
1) Patient Financials
The goal here is to reduce the risks associated with the double whammy of payment delays and claim denials.
To reduce payment delays, is the patient given financial option counselling? Is the patient being advised of anticipated costs? Is a payment solution being offered such as verification of coverage, insurance or self-pay?
“Clean claims” are routine ones the back office staff can deal with quickly that require little in the way of denial management for healthcare. The tough claims, the “exceptions,” can slow processing overall and negatively impart cash flow. If you assessment suggests this may happened in the short term after ICD-10 implementation, consider co-sourcing outside AR Resolution Specialists.
As to why exceptions are occurring in the first place, consider co-sourcing an RCM company to work with your staff to identify and fix any glitches.
If your assessment suggests that there could be logjams during the first weeks of ICD-10 implementation, make sure your coders have all the tools they need to plough through them quickly. Provide tools and resources that are accessible from their PC such as those available from the CMS.
3) Documentation (EMR)
Coding and claims submission begin upstream with medical documentation (EMR) which are in the hands of the physicians. In your assessment, consider doing some chart audits to see if physicians need any additional training. Also, are the physicians comfortable with the system updates? Can EMR templates be improved to make the physicians’ tasks easier or more user-friendly?
If the physicians are happy and comfortable with the new system, the downstream processes will flow more smoothly
Another useful tool from the CMS
Get CMS ICD-10 Coding Guides for Medical Specialties
Are You Where You Should be at this time for ICD-10?
If you need help, Nearterm RCM Consultants can help with a gap analysis and an action plan. Ask A Nearterm Expert.