Monitor

ICD-10, One Year Later: What’s the Impact on Revenue Cycle Management?

Healthcare providers went through a massive change in billing operations last year, as the shift from ICD-9 to ICD-10 went into effect on Oct. 1, 2015.

The new coding system brought with it not only an increase in diagnostic codes (from about 14,000 to over 68,000) and procedure codes (from 4,000 to 87,000), but also an increase in operational concerns for providers. Even though the ultimate goal of ICD-10 was to improve quality reporting and outcomes measurement, and also to bring efficiency to reimbursement processes, providers around the country feared the shift would cause productivity to plummet, as well as increased denials and reduced revenue.

Other developed countries such as Canada, Australia and various countries throughout Europe transitioned to ICD-10 years before the United States, and had a rough go of it. Canada’s healthcare system, for instance, reported a 50% drop in coder activity after the implementation of ICD-10 in 2001. 

But in the United States, the numbers did not suffer nearly as much. Initially, the industry reported a decrease of only 25% in charts coded per hour. And a year after implementation, coding productivity has stabilized and now providers report only a 10-15% decrease.

Optimally-trained billing staffs reduced the chance of negative impact on healthcare facilities. To that end, Regent Revenue Cycle Management (Regent RCM) provides tenured, proven revenue cycle management to ambulatory surgery centers (ASCs) with the skills to handle ICD-10 efficiently.

“Our team understands how ICD-10 can impact each segment of the revenue cycle from claim denials to days outstanding/days in A/R,” said Michael Orseno, VP of Revenue Cycle at Regent RCM. “It has been a year since ICD-10 implementation and our team has mastered the changes and updates. Your center may have a solid business office in-house who can sufficiently handle RCM; but if not, consider transitioning to outsourced RCM services with an external provider that is fully prepared.”

If you’re considering outsourcing to optimize your center’s revenue cycle, Ed Tschan and the experienced team at Regent RCM are available to your answer questions, explore a revenue cycle audit or discuss a cost benefit analysis. Ed can be reached directly at 312-882-7228.

Reasons to Outsource

Top 6 Reasons to Outsource RCM – Part Two

Why is the revenue cycle management (RCM) market projected to experience a 12 percent uptick in growth through 2021? Two primary forces are at play: Value-based care’s emphasis on improving quality while reducing costs, and the increased complexity that comes with a more accountable organization. Ambulatory surgery center (ASC) leaders see the need to achieve real transparency, predictability, and performance, and outsourcing RCM is the ideal way to increase cash flow, cut costs and optimize their centers’ revenue cycle.

In a two-part series, we identify the top six reasons for outsourcing RCM. The first blog focused on expertise, technology and staffing. This second installment focuses on transparent reporting, legalities and location-specific savings.

  1. Transparent Reporting. While ASCs often lack the necessary expertise, technology and resources, or time needed to devote to transparent measurement and reporting, outsourcing these processes offers access to the tools and expertise needed to analyze the data and track changes in financial performance. Expertise with third party reporting software allows revenue cycle experts to pull specific reports to find the root cause of a problem. For example, outsourcing RCM can help determine what it means if an ASC has either a very low or very high percentage of A/R over 90 days. The center can then take steps to correct course.
  2. Keep up with rules and regulations. Never has it been so important to stay abreast of healthcare laws and regulations. ICD-10, for example, is constantly re-shaping coding, and ASCs must stay ahead of the curve. But centers also have numerous otherpriorities that must be completed, and new regulations can fall through the cracks. Outsourced RCM vendors, by the nature of their business, proactively keep tabs on industry laws and regulations.
  3. Save space to enhance revenue. Outsourcing RCM can create added space within a facility, and the extra square footage can be used to enhance value added aspects of the business. More testing equipment can be brought in for example, enabling services that create an increase in revenue. Outsourcing RCM frees up physical space in an ASC, and that can give centers the opportunity to add new services, which can be beneficial financially.

Are you considering outsourcing to optimize your center’s revenue cycle? We are available to your answer questions and discuss if a revenue cycle evaluation makes sense for you. 312-882-7228.

If you missed part one, read it here.

Insurance coding statement

Four Additional ICD-10 Coding Tips

Building on a recent ICD-10 coding post, Mary Bort, Director of Coding at Surgical Notes, MDP, LP, and Regent RCM coding partner, shares four more coding tips aimed at helping ASCs succeed while implementing new ICD-10 codes.

  1. Claim Rejection for CMS

The procedures for correcting and resubmitting rejected claims and issues related to denied claims have not changed with ICD-10, so submitters should follow their existing billing procedures. CMS will not reject claims because of lack of specificity required for a National Coverage Determination (NCD), Local Coverage Determination (LCD) or other claim edit.

  1. Dates of Service

For outpatient and physician reporting, the proper CPT code set is driven by the date of service, NOT by the billing date. Claims for dates of service on and subsequent to October 1, 2015 must be coded in ICD-10. Claims for dates of service prior to October 1, 2015 must be coded in ICD-9 – any claims for dates of service after October 1, 2015 that contain ICD-9 codes will be rejected. There is no dual code reporting, so claims cannot contain both ICD-9 and ICD-10 codes.

  1. HIPAA (Health Insurance Portability and Accountability Act of 1996)

While HIPAA covered entities are required to accept ICD-10 codes as of October 1, 2015, entities that are not covered under HIPAA are NOT required to accept ICD-10 codes.

Covered Under HIPAA:

  • CMS
  • Commercial payers such as Aetna, BCBS and United Healthcare
  • Federal payers such as Medicaid

Not covered under HIPAA:

  • Attorneys
  • Lien companies
  • Workers compensation carriers
  • Auto insurance

NOTE: According to iHeathBeat, California, Maryland, Louisiana and Montana will continue to use ICD-9 for Medicaid fee-for-service programs – Medicare has approved a delay for those state Medicaid programs due to inability to process ICD-10 codes. Other carriers will have to adhere to the rules if they are a HIPAA covered entity, regardless of the state.

  1. Types of Testing

If a center has not yet performed ICD-10 testing, it should perform content-based testing, internal, and external testing. Content-based testing can identify gaps in a center’s ICD-10 upgrades and should be performed to assess surgeons’ documentation and coders’ ability to code in ICD-10. Internal testing should be conducted to evaluate a practice’s ability to create and use ICD-10 codes throughout the patient workflow in place of ICD-9 codes. External testing should be performed with internal trading partners, such as billing service, clearinghouse and payers, to test a center’s ability to send and receive transactions that use ICD-10 testing. This will include acknowledgement testing and end-to-end testing.

The rapidly changing health care market presents both challenges and opportunities. Partners like Regent RCM and Surgical Notes can provide customized solutions and streamlined processes. Click here to contact Regent RCM and connect with an RCM expert or click here to contact Surgical Notes for coding or transcription specific questions.

Ed Tschan, Regent RCM Director of Business Development,
etschan@regentsurgicalhealth.com

Don Callender, Surgical Notes, Central Region Sales Director,
dcallender@surgicalnotes.com

Insurance coding statement

Four ICD-10 Coding Tips

ICD-10 is here – and Mary Bort, Director of Coding at Surgical Notes, MDP, LP, Regent RCM coding partner, weighs in and shares four coding tips to help ASCs succeed while putting new ICD-10 codes into practice.

  1. Up-to-date ICD-10 templates

To safeguard against claim rejection, verify that all of your templates (EMR’s, transcription, etc.) to confirm that they meet ICD-10 standards and comply with the specificity need for ICD-10 coding.  While this step should have taken place prior to ICD-10 going live, it is critical to update existing templates to me the new documentation requirements. This includes the features available in custom template designs that can better fit each health care organization’s workflow.

  1. Clinical documentation

The highest specificity of documentation should be used with the implementation of ICD-10. This does not mean that health care providers need to have an increased amount of documentation, but rather that the documentation is more precise including anatomical site or location, laterality and episode of care.

  1. Unspecified codes

As part of the ICD-10 Official Guidelines for Coding and Reporting, all HIPAA-covered entities must comply, however unspecified codes are still available when documentation does not support a higher level of specificity. The unspecified codes often have necessary and acceptable uses. For example, when sufficient clinical information is not known or available about a health condition, and the coder is unable to assign a more specific code, it is acceptable to report the appropriate “unspecified” code.

  1. Flexibility with family of codes

Family of codes refers to the three characters of an ICD-10 code. These are codes within the same category that are clinically related but provide differences in capturing specific information on the type of condition. For example, Crohn’s disease is in the K50 family. To include a Crohn’s disease diagnosis on a claim, a valid code must be selected. As long as the selected valid code is within the K50 family, then the audit flexibility applies.

With the challenges presented by the rapidly changing health care market, including documentation and coding challenges related to ICD-10, partners like Regent RCM can provide customized solutions and streamlined processes. Click here to contact Regent RCM and connect with an RCM expert or click here to contact Surgical Notes for coding or transcription specific information.

Ed Tschan, Regent RCM Director of Business Development, etschan@regentsurgicalhealth.com

Don Callender, Surgical Notes, Central Region Sales Director, DCallender@surgicalnotes.com

 

Regent RCM

Regent RCM Health Care Industry News | September 2015

Each month Regent RCM explores the top news and headlines affecting the health care industry. 

This month in the news: The implementation of ICD-10 is less than 10 days away, Medicare transitions into a bundled payment model, and there is expected healthy job growth for those interested in a medical coding career.

Implementation of ICD-10

On October 1, Medicare will reject all claims that do not contain coding that complies with the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (IDC-10). ICD-10 is an important and vital change in the health care industry. Have you completed the recommended 8 Steps your ASC must take to prepare for the ICD-10 launch in two weeks? We debunked some common myths surrounding the updated coding system, and if you haven’t already, now is the time to focus on ensuring that your ASC is completely ready for the transition. Click here for more resources to prepare for ICD-10.

Addressing Bundled Payment Cost Reduction Challenges

As part of the Affordable Care Act (ACA), Medicare will transition into a bundled payment model for hip and knee replacements. With the upcoming bundled payment testing, hospitals and revenue cycle management companies must connect the distance between the initial investment and an uncertain return on investment. Knowing the cost benefit ratios in revenue cycle management is key to avoiding bundled payment cost reduction challenges, as many people believe bundled payments are the way of the future. Read more on the challenges of bundled payment cost reductions or with probable challenges approaching, learn how outsourcing RCM can be more cost effective.

Job Growth for Medical Coders

October 1 is a huge marker in the health care industry as it is the deadline for health care companies to upgrade to a new coding system and this change should result in good news for those interested in the health care industry. The new coding system implementation will create more jobs for those interested in becoming a medical coder, which does not require a college diploma, with the right training. It is expected to grow by 22 percent by 2022, which is a higher rate compared to other occupations and industries. Click here to read more on the job growth.

Revenue cycle management for ICD-10

Why you shouldn’t wait on ICD-10 testing

The implementation of ICD-10 is quickly approaching. After several years of delay, the deadline for the World Health Organization’s 10th revision of the International Statistical Classification of Diseases and Related Health Problems is set for October 1, 2015, which is now less than 70 days away.

ICD-10 allows for more detailed coding including more than 14,400 different codes, along with the tracking of new diagnoses. ICD-10 also allows for the expansion to more than 68,000 codes through the use of optional sub-classifications.

It’s important that your ambulatory surgery center (ASC) is not only preparing for the implementation of ICD-10, but testing the coding system as well. Instead of a one-time test, it should be an ongoing process to determine any issues in the claims system with coding and/or documentation.

With now less than 70 days until ICD-10 goes into effect, it’s important to start that testing now if you haven’t done so already. Giving your center time to identify and correct any problem areas will help to ensure a smoother overall implementation.

What’s more, a HIMSS study found that coder productivity may be reduced by 20 to 50 percent during the implementation of ICD-10. To keep this percentage as low as possible, testing the new coding system will make your business office staff more proficient in ICD-10 as well as increase their comfort level with the new codes.

ASC ICD-10 Preparation

Top 4 tips to quicken your ASC’s ICD-10 preparation

The implementation of ICD-10 is set for October 1, 2015, and though it’s been delayed previously, this new deadline is set to hold. This means that your ambulatory surgery center should be taking the necessary steps to prepare to use 10th addition of the International Classification of Diseases by the World Health Organization (WHO).

We recently debunked some common myths surrounding the updated coding system, and if you haven’t already, it’s now the time to turn your focus on ensuring that your ASC is completely ready for the transition. With less than 100 days until October 1, use these tips to optimize your time as you prepare for ICD-10 to ensure your center is ready. And remember, improper preparation can have negative impact on key performance indicator (KPI) metrics such as AR days and revenue.

Focus on small-scale successes

With the deadline fast approaching, gradual improvements are no longer an option. Instead your center should shift its focus to repeated small-scale successes in order to produce outcomes in a tangible process.

Change the perception

Many of your staff members may view ICD-10 as an unnecessary complication. Changing their perception of the coding system by hosting meetings regularly to review the new codes will make business office employees feel more comfortable and confident, making the system easier to adopt when the time comes. You can also have your staff use online tools to look up, verify and validate codes, which will reduce incorrect codes from being input.

Cut down meeting times

Instead of a more traditional approach to planning and preparation, you should now think outside the box with a different structure for project management. Instead of lengthy status meetings once a month, plan on shorter daily or weekly meetings to keep your revenue cycle specialists on track with their progress.

Assess your internal capabilities

Some centers may have a solid business office in house who can sufficiently handle the transition to ICD-10 without a negative impact on KPIs. It’s important to assess whether or not your internal revenue cycle specialists can manage the implementation. If the answer is no or you are not sure, you might want to consider transitioning to outsourced revenue cycle management services with an external provider that is fully prepared.

Becker's ASC Review Conference

Learn more about Regent RCM at the upcoming Becker’s ASC conference at booth #31

Regent RCM will be attending Becker’s 13th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference & the Future of the Spine in our hometown of Chicago, Ill., from June 11 through June 12, 2015. We look forward to Becker’s each year as an opportunity to network with those across our industry and provide fresh insights on revenue cycle strategy and best practices.

What are the benefits of outsourcing RCM?

Be sure to stop by Regent RCM’s exhibitor booth #31 at the conference to learn more about the benefits of outsourcing RCM for ASCs. We understand that maintaining a successful and healthy revenue cycle management strategy requires a great deal of time, resources and expertise. If your center cannot dedicate internal staff and resources to RCM, outsourcing may be a smart business move.

Learn about reporting and analytics

This is also an opportunity to discover the importance of reporting and analytics for your center. We are thrilled to have Steve Taylor from ASCInsight joining us to provide live demos during the conference. Steve will be demonstrating how you can configure a real-time dashboard for both financial and clinical key performance indicators (KPIs). He will also offer insight on creating and configuring customized reports and well as those that come standard with the platform.

Sign up a free business office audit

To determine the financial health of your center quantitatively and qualitatively and gain a better understanding of your strengths and opportunities, be sure to sign up on site for a free business office audit that focuses on observations, reimbursement, coding and staffing.

To schedule an on-site appointment, contact Regent RCM Director of Business Development Ed Tschan at (312) 882-7228 or etschan@regentrcm.com.

ASC benchmarking

What does it take to get your center healthy?

For an ambulatory surgery center to be financially healthy, it requires that data, analytics and reporting tools be set in place to monitor the success of certain key performance indicators (KPIs) that allow the center to be in total control of the revenue cycle.

If an ASC does not have visibility of these KPIs via a real-time management console or analytics tools, no one might realize that there is a problem within the revenue cycle, which could ultimately cause significant revenue and timing challenges.

Signs an ASC is not financially healthy

There are a few tell-tale beacons to watch for to determine your center’s financial health:

  • A monthly decline in revenue
  • A monthly increase in A/R days

If these changes occur, a center must immediately begin to examine the root cause of the issues and formulate a plan of attack to regain consistent performance and overall financial health.

Improving an ASC’s financial health

Ultimately, successful financial health comes down to this: Revenues exceeding expenses. On the cost side, you should examine business office staffing costs to determine if they’re optimized with the right people in the right roles. On the revenue side, you should look at revenue per case as well as the revenue per contract. Each contract should be uploaded into the management information system (MIS), and every revenue cycle specialist should have an intimate understanding of each contract. This ensures that the correct reimbursement is being received.

To begin to understand your center’s financial health status, you can take a proactive first step and complete a business office audit to determine what issues exist, where the issues are and where changes need to occur.

Once you recognize the need to improve your ASC’s financial health, the center has two options: Keep RCM internal or outsource RCM.

To make this decision, it’s best to objectively analyze your center’s capabilities and strategies. If your center has the resources, expertise, technology and performance to not only sustain a healthy revenue cycle but improve upon it, you can implement internal changes. However, if this is not the case, then outsourcing RCM to an organization that’s dedicated to each piece of the revenue cycle may be the best top line and bottom line approach.

ASCA 2015 Conference Regent RCM

Regent RCM is Live from ASCA 2015

This week, Regent RCM’s leadership team headed down to Orlando, Fla. to participate in ASCA 2015, the premier meeting for those in the ambulatory surgery center (ASC) industry.

ASCA 2015 has been a great opportunity for Regent RCM’s Director, Michael Orseno, Director of Business Development, Ed Tschan and Revenue Cycle Coordinator Leslie Favela to network with other industry professionals and provide useful insight on how the benefits of outsourcing RCM can have positive long-term effects on a center’s financial health.

There have certainly been some conversational themes our team has noticed since they arrived at the conference. Some of the key discussion points have included:

Regent RCM will be exhibiting at ASCA 2015 through the end of the conference so be sure to stop by booth #413 to say hello and learn more about how outsourcing RCM might be the right decision for your ASC’s billing and collections needs.

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