GeBBS Healthcare Blog

By Nitin Thakor, GeBBS President & CEO

The way patients want to receive their medical treatment is creating significant growth in two types of healthcare delivery facilities: Urgent Care Centers and Free Standing Emergency Departments.

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The world did not come to an end on October 1, 2015. With the start of ICD-10, healthcare professionals anticipated an overall reduction in productivity of their billing staff. In a pre-October 1 survey, 94% of respondents indicated that they expected increased denials, but only 30% had done any work toward solving the problem. 

If you are one of these, you are suggested to begin immediately to improve your denial management processes and your ICD-10 coding. Most providers, payers, and even CMS expect there will be a noticeable increase in the coding denial ratios, which currently range between 15-20%, and may actually double. Though, by design, ICD-10 is expected to reduce the denial rates; in the short term there is bound to be reduced collections, higher denial ratios, and lower productivity.

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October 1st is almost here.  Here is a quick checklist to ensure you are ready:

1. Have you identified the top ICD-9 diagnoses and trained appropriate staff on the corresponding ICD-10 coding for billing and clinical documentation?
2. Have you reviewed current clinical documentation and identified gaps for ICD-10 requirements?
3. Have you contacted all your vendors to ensure they are ICD-10 compliant, such as payers, clearinghouses, and any outside vendors?
4. Have you tested submitting codes to your payers and clearinghouses?

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If you are getting a late start on ICD-10 preparation, don’t worry; there are still cost-effective and viable solutions that can help you meet the October 1 deadline – outsourcing and technology.

The transition to ICD-10 will have a tremendous impact on your organization and its revenue stream. If you are getting a late start on ICD-10, you may want to consider using an outside partner, who has been diligently preparing for the ICD-10 transition for several years. An outsourcing partner can provide immediate expertise to ensure your revenue risk is minimized. 

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The Centers for Medicare & Medicaid Services (CMS) has begun paying providers for delivering non-face-to-face care to their Medicare patients with two or more chronic conditions. This is a win-win for everyone involved in the process. Patients will experience improved outcomes and physicians have the opportunity to increase their revenue streams. CMS created the new CPT Code 99490 to reimburse providers for spending 20 minutes per month helping their patients manage multiple chronic conditions.

Medicare has traditionally only paid providers for care management services as part of face-to-face office visits. Now, eligible providers will be reimbursed at approximately $42 per qualified patient per month for these services. The Chronic Care Management (CCM) payment applies to both Medicare and Medicare Advantage patients.

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The 2015 Medicare Physician Fee Schedule (PFS) will pay for non-face-to-face services for CPT Code 99490 -- Chronic Care Management (CCM), reimbursing practices on an average of $42 per patient, per month. Of all the governmental mandates that have come along -- this is a good one. It incentivizes physicians to extend their care management and care coordination services to their patients who need it the most, and it will improve outcomes for critically-ill patients. 

CMS has recognized that in the U.S. seven of the top ten causes of death are from chronic illnesses, with 85 percent of healthcare costs going to treat those diseases and two-thirds of Medicare dollars being spent on patients with five or more of these chronic conditions. 

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October 1 is just around the corner. There is no other way to express it. Are you ready?  Training to ensure you are ready for ICD-10 is the most critical factor in preparation. You should determine your staff’s training needs based on their individual roles within your organization. Staff members will require different and specific education based on their role in the ICD-10 coding process.

First and foremost, select an experienced training partner such as GeBBS!

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Dual ICD-9/ICD-10 coding can generate benefits that far outweigh the negatives, if it can be done without creating productivity declines and revenue cycle slowdowns.

There is a huge cost factor to dual coding if you have to do it manually; however, there is a way to dual code without involving every coder on your staff in the process. Technology is available today in the form of computer-assisted coding (CAC) tools.  CAC is a proven technology that automatically derives and assigns ICD-10 medical codes from within your clinical documentation with a 95% accuracy rate. For GeBBS, its proprietary algorithm built in its iCode coding platform leverages deep data learning principles of both ICD-9 and ICD -10 codes.

With this kind of technology, your organization can dual code in ICD-10, while still maintaining your present ICD-9 workload.  These CAC technology solutions can work with your electronic health record (EHR) and financial systems to produce extremely accurate coding.

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Healthcare consumerism is going to be an important factor in the new healthcare financial environment where a number of patients are going to be responsible for a portion of their healthcare costs. Empowering healthcare consumers to schedule appointments, receive online statements, and make electronic payments are just a few of the options that consumers are demanding.

How can today’s healthcare providers meet this increased demand for consumerism in their healthcare delivery? One solution is to employ a professional, outsourced, state-of-the-art call center that can exclusively handle your patient inquiries.  This center can offer the up-to-date infrastructure you need to handle heavy call traffic and manage call volume peaks and valleys with ease. Experienced healthcare billing professionals can provide quick resolutions to patient issues and queries. 

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Patient access management department structures vary among hospitals, but in best-performing facilities, patient access management functions are typically structured with their patient access staff members divided into three areas: pre-service, time of service and post-service to handle the issues unique to these processes at each stage in the continuum of care.

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