Revenue Cycle: Post ICD-10 Risk Mitigation Planning
Are you frequently reviewing your post ICD-10 risk mitigations plan? Did you even create a post implementation risk mitigation plan for your revenue cycle? If the answer is no to either of these questions don’t worry it is not too late to do something. The greatest risk areas in the revenue cycle is a delay in cash flow. You can start a simple risk mitigation plan by asking yourself some simple questions:
- Has your unbilled AR stabilized since ICD-10? If not, what steps are being taken to bring the unbilled to normal levels?
- Have you seen a decrease in your clean claim percentage? Do you have the infrastructure to call payer customer service or be able to check the status of claims in doubt?
- Are you seeing an increase in denials? Is there an uptick in denials due to coding, medical necessity, NCD/LCD or other ICD-10 related activity appear to be happening?
- Have you seen a change in your average days to pay for your top 5 payers? For dates of service post 10/1/15, do claim payments appear to be stretching (example: what was cleanly paid in 14 days, is now taking longer)?
If you answered, "I don’t know" to any of these questions you should spend some time investigating until you have a concrete yes or no answer. If you answered yes to any of these issues you should identify steps that can be taken to mitigate the issues. If you do not have capacity to resolve the issues, you should reach out for help early and hire revenue cycle experts. It is much easier to mitigate issues in one of these areas earlier in the process than later when it has created a significant shortage of cash.
You should make it routine to ask yourself these questions weekly because the unsettledness due to ICD-10 will not end after this initial transition. Already, several state Medicaid programs (CA and MT included) were not ready for ICD-10 and will map the ICD-10 codes to their predecessor (ICD-9) for processing.
VICE PRESIDENT - OUTPARTNERING™ CENTER For HEALTHCARE RESOURCE GROUP, Inc.
Client care is the top priority for Jason Coffin, a Certified Revenue Cycle Expert (CRCE-1), CHFP. Jason oversees all operations of HRG’s OutPartnering™ Center located in Spokane Valley, Washington and is responsible for Central Business Office (CBO), Extended Business Office (EBO), self-pay and quality assurance services. He is focused on continuous improvement initiatives to ensure HRG remains the best choice for healthcare providers. Jason and his team provide outsourced revenue cycle services and support to hospitals and clinics throughout the country.
BUSINESS INTELLIGENCE MANAGER FOR HEALTHCARE RESOURCE GROUP, INC.
Kerry has over 30 years of healthcare revenue cycle management experience on both the payer and provider side. Over the course of his career, Kerry has developed an abundance of expertise in Medicare Part B reimbursement and has published several comments in the Federal Register.