ICD10 – Impact on Revenue Cycle. Agenda Introduction What the industry is saying What I think is going to happen How can you be best prepared

ICD10 – Impact on Revenue Cycle

Agenda

• Introduction• What the industry is saying• What I think is going to happen• How can you be best prepared

Introduction

T Minus 21…

Introduction

And Counting!

Introduction

• Situation:– You've been involved in a water-skiing accident

where your skis have caught fire and now you are being rushed to the emergency room.

Introduction

Introduction

• The Good News:– There a code for that in ICD-10-CM.

• The Bad News:– You'll be delayed while the medical administrator

chooses between the 6 different codes for this exact situation.

Introduction

Introduction

What we would like to be doing!

Introduction

What we really are doing!

Introduction

• ICD10 and the Revenue Cycle……..• Are we talking the front of the parade?• Or the back of the parade?• We would like to think about being in the

front….• But we absolutely need to be talking about

the back! • Because that is where the money is!

Introduction

Assessment

Problem Identification

Documentation

Code Selection

Visit Processing

Claim GenerationClaim

Transmission

Acceptance

The Revenue Cycle

Payment

Adjudication

Introduction

• ICD10 is here to stay this time.• So the biggest question is………..• What is going to happen come October 1st?• The answer is……………………..• Nobody knows for sure.

What the industry is saying

• Robert Tennant – Director of Health Information Technology Policy - MGMA.

– There are 3 big concerns:» Vendor software readiness» Physician coding readiness» Cash flow impact from higher denials and

lower productivity


• Fred Pennic – Founder of HIT Consultant– In a NaviCure readiness survey of physicians from

earlier this year:» 81% believe they will be ready for 10/1/2015» 75% expect a productivity loss up to 40%» 41% believe payers will not be ready» 23% say they do not have time to prepare


• Michelle Cavanaugh, RN, CPC – ICD-10 Trainer and Certified Medical Reimbursement Specialist

– Spend money now to be ready. Expect to spend at least $2,000 to $3,000 per practitioner.

– Set aside cash reserves or apply for a line of credit as the cash flow impact could go as high as 30%.

– Clean up AR now.– The key to success lies in accurate

documentation. – Denial Management is going to require more

physician involvement slowing turnaround time.


• Summary– The transition is not going to be easy.– Productivity will be impacted.– Physicians need to understand the implications of

ICD10 coding on documentation.– Improve your cash reserves now.– Clean up what you can today.– Focus attention on the codes most commonly

used in your practice.

What I think is going to happen

• Cash flow will take a hit.– The payers’ adjudication systems are going

through a total re-write. This has not happened for the entire time I have been in the industry (31 years). There WILL be issues.

– This is NEW to everyone. If you think this will be smooth sailing, you are fooling yourself.

– Most everyone understands that productivity will be impacted and that it will have a direct and immediate impact on cash flow.


• The Vendor and Clearinghouse software will not be the biggest issue.

– Our part of this change is already in place and has been tested.

– If you are on CPS 11 or higher, the ICD10 codes are available.

– On the outbound 5010 claim form, there is a Diagnosis Code qualifier that tells the payer if the code is ICD9 or ICD10. All other fields are unchanged.

– We have tested and confirmed that this is working.


• But software set up will be.– The coding maps from ICD9 to ICD10 are crucial. – Templates for charting must be adjusted to

support enhanced documentation requirements.– The Insurance carrier set up needs to be accurate

in order to ensure that the right code goes out on the right claim.


• The Payers are going to loosen their edits.– They do NOT want to be the stumbling block in the

process. It would not be good for them to hold up paying valid claims.

– They have no history in the ICD10 world to go on so in the beginning, they will be more likely to pay claim with a valid code than deny it.

– The caveat here is that they may come back after the fact and change the re-imbursement which they have been known to do.


• Providers who have prepared for this will be better off than those who did not.

– Because documentation is the biggest challenge, if you prepared for this, there will be less clean up work to do after the fact.

– For those who wait, coding may not be correct and if by chance it is, there is a high likelihood that the documentation will not support it.

– It may not come to light as a problem until later and then it becomes a much bigger problem to solve.

How can you be best prepared?

• Get a checklist and make sure you have completed all steps.


• Here is one you could follow:– Make sure you have “Current” documentation on

ICD10 codes.– Concentrate your efforts on the “most common”

codes used by your physicians and the practice.– Work to ensure that your EMR is set up to support

the new coding and documentation requirements. » Are your problems lists updated?» Are your templates (forms) updated?

– Set up a Command Center for the cutover.– Ensure you put ongoing Education in place for the

days and weeks beyond 10/1/2015.– Err on the side of providing more communication, not

less.


• Leverage Resources available to you:– CMS

» https://www.cms.gov/Medicare/Coding/ICD10/index.html

– GE» https://

engage.gehealthcare.com/community/en/cps/cps-icd-10?et=watches.email.document

– Visualutions» http://www.visualutions.com/icd_10_webinar_s

eries/

.

https://www.cms.gov/Medicare/Coding/ICD10/index.html



https://engage.gehealthcare.com/community/en/cps/cps-icd-10?et=watches.email.document



http://www.visualutions.com/icd_10_webinar_series/




• Don’t be a stranger to your major payers.• Analyze your payment history with your

payers.• Reach out to them and ask them what their

contingency plan is for adjudication.• Suggest that they consider an “estimated”

payment schedule with you for the first few months after 10/1/2015.

• Don’t be afraid to ask for help from these people.


• If you are not sure about anything, just ask.• If you don’t ask, no one will know how to help

you.

Conclusion

• The change is coming. • No one really knows what it will mean for us.• However, there is an army of people who

have worked to prepare for this and there will be an army of people ready to help navigate the waters after 10/1/2015.

• The good news is that we are all in it together.

• And if we all stay focused on those things that matter most, we will find a way to solve the problems that come up.

Download all conference presentations at

visualutions.com/ug15conference

Join our newsletter and stay up to date!visualutions.com/newsletters

Thank you.

Documents

ICD10 – Impact on Revenue Cycle. Agenda Introduction What the industry is saying What I think is going to happen How can you be best prepared