ICD-10 deadline may improve finances

March 3, 2013 in Medical Technology


As the ICD-10 deadline looms closer, many healthcare organizations are still trying to come up with the most effective communications, collaboration and testing strategies to assure implementation of the diagnostic and procedural code set change. 

The transition to ICD-10 by October 2014 has many pain points, and one of them is to understand the impact on the revenue cycle throughout the organization, whether front end, middle where coding resides and back end, according to Joe Artime, regional vice president for enterprise business solutions at Parallon.   

The ICD-10 Symposium, “All Hands on Deck: Implementation, Optimization and Weathering the Perfect Storm,” offered approaches for those still wrestling with their strategy within a single hospital and across multiple providers on Sunday at the 2013 HIMSS Annual Conference Exhibition.

One of those approaches is to view ICD-10 as an opportunity to improve the financial performance of the enterprise through collaboration.  

For example, organizations should analyze their financial performance using ICD-9 to fix and improve it and to better prepare for ICD-10. “We have probably talked with payers and managed care contractors, but have we really looked at the impact together?” asked Artime. “Payers should be at your ICD-10 planning meetings.” 

Also, it is important to understand how cash flow is impacted and where and how to manage other resources because of the deadline delay. Resources have to be available to cover risks, Artime said

Financial pain points can affect contracting, denials, under-coding, and over-coding, according to Ed Hock, senior director of The Advisory Board Company. He recommended first defining a strategy to address the issue. This includes the “specific to-do on how and who to mitigate this. Also, strategies need a budget. Pick the right strategy that fits your organization. Each level of the ICD-10 team all the way up to the executive should coordinate on fixing issues.

“It’s important for executives to consider what is acceptable slippage of net revenue because there is a cost to mitigating the impact,” Hock said.  

Even in well-planned implementations, hospitals can face revenue losses because of insufficient scope of transition activities. For example, in the case of a hospital, it could be insufficient coder staffing available before the transition, lower payment for procedures as a result of more specific codes, and failure to follow through on required redesign of documentation tools, Hock said.

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