GeBBS Healthcare Blog

Early test results reported in Becker’s Hospital Review from data gathered by HIMSS and WEDI indicate that only 63% of ICD-10 documentation was accurately coded.   In addition, coders averaged only two medical records per hour, compared with four per hour under ICD-9, which equates to a 50 percent drop in productivity.

The effects of weak revenue cycle management can go well beyond just financial challenges. Revenue problems can also lead to patient dissatisfaction challenges, and this can lead to reimbursement problems. Why do so many hospitals experience problems with their revenue cycle? A good explanation is that busy healthcare providers are challenged to keep abreast with the rapidly changing and complex payer requirements for pre-authorizations, medical necessity checking, new coding mandates, accurate charge capture, reporting requirements and a plethora of other financial challenges. This is compounded by the rise in self-pay patients and the inefficient data that supports the collection of these accounts. In general, many providers just don’t have the time to efficiently and effectively monitor their revenue cycle across the enterprise.

Is your clinical documentation ready for ICD-10? CMS has prepared a guide called Simple Steps to Improve Clinical Documentation; it’s worth your time to review it.

As a healthcare provider, you do not need to outsource any of your revenue cycle management activities , provided that the following are all true:

Inefficient revenue cycle management (RCM) and outdated RCM technologies are causing almost unbearable pain for many medical practices. These RM inefficiencies are resulting in extreme financial hardships, to the point that in a recent survey conducted by Black Book, a technology and services market research and opinion company, 87 percent of practice managers believe their revenue cycle management is so out-of-date and inefficient, it will result in the sale of the practice to a larger physician group or hospital within the next year or the practice will dissolve.

Other astounding facts the survey uncovered were:

One of the worst things that can happen to an airplane pilot is to suffer a stall; that means -- more than likely -- a crash is imminent. Without proper planning, your revenue cycle is headed for a stall after the October 1, 2014 ICD-10 transition deadline. It’s critical that you devise a strategy NOW to avoid an ICD-10 claims backlog and a deadly stall for your accounts receivable.

The healthcare industry is justifiably apprehensive about the impending transition from ICD-9 to ICD-10. Between claim denials from incorrect coding and coders taking more time to deal with the new system, billing is more than likely to slow down considerably. However, The Centers for Medicare and Medicaid (CMS) officials are saying that preparation and planning should keep providers’ accounts receivable from collapsing completely. The agency knows there are going to be claim denials, but they also contend there are ways to avoid many of them.

The American Hospital Association (AHA) Central Office director of coding and classification Nelly Leon-Chisen, RHIA, has authored the 2014 edition of the ICD-10-CM and ICD-10-PCS Coding Handbook, which was published recently and is now available.

Implementing health information technology in a secure manner is an extremely important issue in the healthcare industry.  To remain effective and efficient, healthcare providers must utilize the latest information technology solutions.  These IT solutions require the electronic storage and transmission of sensitive patient data. They must be designed, implemented and maintained with advanced IT security measures to ensure proper risk management and compliance with governmental regulations. 

A new report by MarketsandMarkets recently estimated the healthcare IT outsourcing market value will be $50.4 billion by 2018. What is driving this significant growth in the healthcare marketplace? The global market is forecast to grow at a compound annual growth rate (CAGR) of 7.6%, to reach $50.4 billion by 2018 from $35 billion in 2013. Many industry observers are suggesting that the growth is fueled by outsourcing’s ability to provide an efficient solution for mitigating rising healthcare costs and for helping to meet the growing demand for quality care.