PROTECTING CASH FLOW DURING THE ICD-10 TRANSITION

Transcription

1 PROTECTING CASH FLOW DURING THE ICD-10 TRANSITION

2 The transition to ICD-10 will broadly impact every medical practice s revenue cycle. Practices must examine their revenue cycle management processes now to make sure they are prepared and not impacted severely by ICD-10. Some of the factors already impacting practice s cash flow and profitability include: 1. Changing reimbursement caused by shifting reimbursement models (e.g., fee-for-service vs. value-based), lower fee schedules, slowed or delayed payment, and more. 2. Declining patient utilization, growing patient payment responsibility and bad debt. 3. Higher operating costs. 4. Increasing regulatory mandates. 5. Uncertainty about the future of government-based reimbursement. ICD Navicure, Inc. All rights reserved. No reproduction without permission. 2

3 Practices will incur direct and indirect costs associated with the ICD-10 transition. Example costs to consider include: Time and expense for staff education Prior-authorization, referral, payer contract and medical policy review, and other business processes reviews and changes Costs associated with IT upgrades, updates and/or purchases 2013 Navicure, Inc. All rights reserved. No reproduction without permission. 3

4 If past industry transitions such as 5010 and NPI are any indication, practices will experience decreased cash flow and productivity. At implementation, practices will likely notice: Staff productivity declines of 20%-40% 1 Increased denial rates of 100%-200% 2 Payer claims processing slowdowns due to: Productivity declines if payer staff members are not well-trained on ICD-10 updates Potential claims processing mistakes Lack of accurate and timely payer system changes and payment information 1 Johnson K. Implementation of ICD-10: Experiences and lessons learned from a Canadian hospital. AHIMA, 2004.Retrieved from 1 Barnhouse T, Rudman W. You Are Here ICD-10-CM/PCS Status Check: Three Hundred HIM Professionals Report. Journal of AHIMA. June 2013; 84(6): Readying Your Denials Management Strategy for ICD-10, February 2013, Healthcare Financial Management Association, Navicure, Inc. All rights reserved. No reproduction without permission. 4

5 Taking a proactive approach to revenue cycle management (RCM) can help practices understand how their revenue will be impacted as ICD-10 takes effect. To do this, practices must first identify weaknesses in their current revenue cycle well before the ICD-10 transition. Tools capable of analyzing, trending and highlighting anomalies can help individual practices pinpoint their specific areas of revenue exposure that will be created by ICD-10. This knowledge enables practices to mitigate the revenue risks inherent in the ICD-10 conversion Navicure, Inc. All rights reserved. No reproduction without permission. 5

6 Consider how ICD-10 will affect every stage of your revenue cycle. Patient Eligibility Verfication Patient Remittance Posting Claims Submitted/ Resubmitted Patient Collections The Revenue Cycle Payer Remittance Denial Management Lockbox & Remittance Posting 2013 Navicure, Inc. All rights reserved. No reproduction without permission. 6

7 Advanced clearinghouse tools can help practices ensure proactive ICD-10 risk mitigation by: 1. Improving revenue capture 2. Reducing the cost of claims management 2013 Navicure, Inc. All rights reserved. No reproduction without permission. 7

8 Improving revenue capture Practices should begin using automated eligibility and denial management tools now. This will prevent the need to learn how to use new tools PLUS the new code set, all within the few months before ICD-10 implementation on Oct. 1, A few ways automation can help accelerate cash flow include: Eligibility: One of the most common reasons for claims rejections and denials is ineligibility. Retrieving batch or real-time eligibility information from a clearinghouse before rendering a service reduces back-end denials due to ineligibility. Accurate eligibility information also enables practices to collect the patient responsibility for services at the time of service rather than after a payer processes the claim. Secondary claims: Electronic secondary claims submission makes it easier and more cost effective for practices to submit these claims, enabling practices to collect all earned revenue quickly. Clearinghouses can help ensure clean claims by offering smart claim scrubber edits that adapt with use over time to help practices reduce denials and speed payment by insurers. Denial management: Automated denial management and appeal tools can help prevent the loss of earned revenue, as well as speed cash flow Navicure, Inc. All rights reserved. No reproduction without permission. 8

9 Reducing the cost of claims management Practices that decrease their operational costs can use the resulting financial gain to offset ICD-10 costs. To decrease operational costs, keep in mind: Electronic claims submission can substantially reduce the drain on staff productivity caused by the need to submit claims using paper-based processes or payer websites. Electronic remittance advice (ERA) and automatic payment posting can reduce the costly need to manually manage and post insurance payments. Automated reporting and analysis tools, when coupled with other automated processes such as denial and appeal management, allow practices to more easily pinpoint and measure RCM process improvement opportunities. -- Clearinghouse tools can help benchmark key indicators of RCM health both pre- and post-icd-10 implementation. -- Clearinghouse tools can identify problems with individual payers, allowing practices to rectify those issues prior to ICD-10 go-live Navicure, Inc. All rights reserved. No reproduction without permission. 9

10 Clearinghouses and practices alike must be well-prepared for the ICD-10 transition to gauge clearinghouse readiness: Watch for statements of readiness to test and ability to accept production ICD-10 transactions from clearinghouses. Look to organizations such as KLAS, MGMA and other medical practice management organizations for evidence of preparation and ability to execute for maximum protection of practice revenue during prior major industry shifts such as 5010 and NPI. Previous performance is the best indicator of future performance. A good clearinghouse streamlines your entire revenue cycle process. It is transparent: it lets you see the entire life cycle of every claim to ensure you are appropriately paid Navicure, Inc. All rights reserved. No reproduction without permission. 10

11 Any processes that are broken or do not work well now will only get worse once ICD-10 arrives, so make sure to: Identify rejection and denial problems now. Fix any operational inefficiencies now. In addition, make sure a solid client service safety net is in place. Technology is only part of the answer; personal help is necessary, too. When a practice tries to call its clearinghouse because its denial rate has skyrocketed, for example, the last thing it wants to hear is: All operators are currently helping other customers. Your wait time is approximately one hour. All clearinghouses are not the same. Look for a clearinghouse with: A track record for providing superior client service. Educational resources available to clients to help ensure that transitions such as ICD-10 go as smoothly as possible 2013 Navicure, Inc. All rights reserved. No reproduction without permission. 11

12 The time to review your revenue cycle management processes is now! Still constantly looking for lost claims, solid rejection or denial data, or help with remittance? The window of opportunity to fix these issues is rapidly closing. Revenue cycle management complications and inefficiencies must be addressed before ICD-10 arrives to ensure smooth sailing afterward Navicure, Inc. All rights reserved. No reproduction without permission. 12

13 About Navicure Navicure is a leading medical claims clearinghouse that helps physician practices increase profitability through improved claims reimbursement and staff productivity. Our solutions are supported by the Navicure 3-Ring Policy all support calls are answered within three rings, even during times of transition. Guaranteed. Navicure systems are ready for ICD-10 and we are currently testing the new code set. We are committed to making our clients move to ICD-10 as smooth as possible before, during and after the transition. Navicure is the founding sponsor of a free educational website devoted to making physician practices transitions to ICD-10 easier. Additionally, ICD-10 Analyzer by Navicure ( is a complimentary online tool that enables medical billers to identify the ICD-9 codes that will most impact a user s payer reimbursement and suggest corresponding ICD-10 codes. For more information visit or call NAVICURE. Sink or Swim? Swim through ICD-10 with Navicure. 13