By Nancy Hirschl, BS, CCS, AHIMA-Approved ICD-10 Trainer Vice President, HIM Services, Streamline Health, Inc. For healthcare providers, limiting regulatory and financial risk associated with coding and billing is a core component of organizational compliance. Risks to the mid-revenue cycle can appear in the forms of undercoding, where appropriate revenue is not captured and money [...]
I recently ran across an announcement that I found to be quite interesting. On November 3, 2015, the Department of Health and Human Services (HHS) released proposed requirements for discharge planning for hospitals participating in Medicare and Medicaid. And, the requirements would implement changes from the Improving Medicare Post-Acute Care Transformation Act of 2014. Public comment is open until January 4, 2016. We can expect new rules to go in effect sometime in late 2016 or early 2017.
When preparing to negotiate payer contracts that establish reimbursement rates, many providers don’t realize that this is also an excellent opportunity to assess and improve their overall financial performance. However, this will require operational insight into key metrics in order to objectively assess your organization’s performance while also managing the payer negotiations from a position of strength.
Consumer focus on health records is really heating up. I recently searched Twitter for the phrase “medical records” and found that, between Aug-Sept 2015, the number of news tweets increased by 80% over the previous 6 months. It’s attracting a lot of media attention and people are starting to ask: “Where exactly is my medical record?” and “What kind of information is not included in my medical record?”
We all know that ICD-10 will bring with it a learning curve for coders at provider organizations. Despite all our preparations, training, and dual coding scenarios, there will be an impact to the revenue cycle in terms of higher DNFB due to longer coding times and possibly reduced revenue due to missing specificity.
There’s no denying that the changeover process to ICD-10 is challenging. Most healthcare organizations have competing projects and regulatory priorities. Managing the transition to this new code set—with its increasing complexity and costs—on top of everything else only adds to the stress. Fortunately, both the stress and cost can be mitigated through a planned approach to the transition.
Patient recordkeeping has come a long way in the last decade, moving from paper-based systems to sophisticated EHRs that encourage information exchange and provide us with a wealth of data. Now it’s time to kick things into a higher gear to meet Stage 2 Meaningful Use requirements and improve patient care.
Experts from the Centers for Medicare & Medicaid Services (CMS) estimate ICD-10 will initially result in a decrease in cash flow and loss of revenue. Denial rates are expected to increase by 100 to 200 percent post-implementation—and healthcare organizations will likely feel the burn of declining payments for up to two years after the implementation.
The move to ICD-10 is one the biggest changes to hit the US healthcare system. Hospitals that carefully prepare for the change by planning six months to a year in advance; implementing solutions that will simplify coding, enable machine-readable documentation and facilitate data collection; and establishing training programs that include those systems will not only experience a smoother transition but also see a greater return on their investment.
