GeBBS Healthcare RCM Blog

With the Start of ICD-10, It's Now About Reducing the Denial Rate

Posted on Fri, Oct 23, 2015 @ 07:00 AM

gebbs denial managementThe 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.

If you have been less than diligent in your preparations, two things can help you rescue your revenue cycle from disaster:

EXPERT ICD-10 CODING

Medical coding is the lifeblood of your revenue cycle. Accurate and efficient ICD-10 coding is crucial to meet your financial and compliance goals. You need reliable medical coders who are accurate, productive, and experts in all types of inpatient and outpatient ICD-10 coding. This kind of coding support is available immediately from an experienced outsourcing provider.

When you partner with an outsourcing company for coding services, you add immediate value to your coding and revenue cycle operations. You will have immediate access to highly-trained ICD-10 coders who will improve your coding accuracy and production and eliminate staffing shortages and backlogs, while reducing your overall costs for coding.

DENIAL MANAGEMENT

The second thing you need is denial management support. A revenue cycle outsourcing company can provide access to a large pool of qualified denial management resources that can work in any practice management system or hospital financial environment and understand how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover on and close out A/R.  These analysts are adept at trending denials and looking for patterns of deficiency that will increase cash flow and reduce aging A/R.

Even prior to October, GeBBS has been dual and direct ICD-10 coding for several clients using iCode, a proprietary computer-assisted coding software. They have also helped clients with CDI projects to ensure charting and documentation will adequately support the greater specificity required for ICD-10 diagnoses.

If you feel the “hammer may still drop” on your revenue cycle, there is a solution: obtain outsourced coding assistance and denial management support. There is still time to rescue your revenue cycle.

Tags: ICD-10, Accounts Receivable (A/R), Best Practices, Insurance Billing Solutions

Checklist for ICD-10 and Audit to Confirm Readiness

Posted on Thu, Sep 24, 2015 @ 10:30 AM

11236638-medical-codingOctober 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?

What else do you need to know and consider?

The only other activity that will provide feedback and prepare you for the transition is an ICD-10 audit. An audit of your present ICD-10 coding activities:

- Can focus on your high-risk ICD-10 codes, as well as inform you of your ICD-10 overall readiness from a business and financial risk perspective
- Monitor the readiness of your system vendors
- Ensure everyone in your ICD-10 coding stream is communicating effectively
- Ascertain the readiness of your clinical documentation
- Reveal the true readiness of your coders to handle the ICD-10 transition
- Provide a comprehensive review of your ICD-10 training processes
- Test your readiness to engage payers in the ICD-10 coding transition

A full scale audit of your present processes will give you immediate and accurate feedback on your true readiness for ICD-10. What you don’t know might hurt you!  GeBBS Healthcare Solutions is ready.  Are you?

Tags: ICD-10, Best Practices

Getting a Late Start on ICD-10? Don’t Worry!

Posted on Mon, Sep 14, 2015 @ 06:00 AM

 

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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. 

Working with a knowledgeable outsource partner can also reduce your costs and overhead complexity. Expertise is available and there is no need to face the transition alone. Select your outsourcing partner on the basis of their coding and billing experience and knowledge. All of their coders have undergone a stringent screening process to verify their skill level, education, experience, and level of professionalism. Most are certified RHIT, RHIA, CCS, CCS-P, CPC or CPC-H.

In addition to supporting your increased workload brought on by the transition, they can help you with your denial management, an activity that will be crucial during this critical period. The partner you select should also have a proven and demonstrable record for helping other organizations similar to yours.

An outsourcing partner can also provide targeted training programs to help you retain your most experienced medical coders - those who will be the most valuable during the ICD-10 transition. Your organization’s support, through viable training programs, can be the key to retaining your most experienced staff members’ and help with the transition. They, in turn, can mentor your less-experienced staff during this challenging period.

Finally, technology has dramatically changed the medical coding process within health information management.  Computer-assisted coding or CAC is a cutting edge technology that automatically derives medical codes within clinical documentation.

Healthcare organizations are now able to streamline revenue cycling processes due to CAC while becoming increasingly more compliant with the requirements of payer and quality reporting.  CAC does not eliminate the need for professional medical coders; it simply assists them and makes them more productive. The coders may not be doing as much coding as was done in the past, but they are needed to review productivity and accuracy.

Following are just some of the benefits CAC provides:

  • •    Improved Accuracy

    •    Improved Compliance

    •    Improved Consistency

    •    Improved Productivity

    •    Improved Traceability

Getting a late start does not mean you can’t win the ICD-10 transition race. It just means you have to employ innovative tactics.

Tags: ICD-10, Best Practices

Tips to Make Sure You Are Ready for ICD-10

Posted on Thu, Aug 20, 2015 @ 07:00 AM

 

11236638-medical-coding

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!

  • Identify which are your most frequently used ICD-9 codes. Make sure every person in your coding stream KNOWS the appropriate ICD-10 codes that correspond to your most used ICD-9 codes. This training will go a long way in helping you maintain your revenue cycle for your most used codes.
  • Conduct a high-level review of your process with a gap assessment and analyses.  A gap assessment will help you gain an understanding of where and how ICD-10 will impact your entire organization. The assessment should include your people and their expertise, your business processes, and your technology to determine the impact of ICD-10 enterprise-wide.
  • Plan for additional expenditures in time and resources as you work to prepare for ICD-10.
  • Enlist technology and an experienced outsourced partner to help with your transition.
  • Don’t try to do everything on your own. Technology is available 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. Your organization can streamline your revenue cycle processes with CAC, while becoming increasingly more compliant with the requirements of payer and quality reporting.  These technologies can work with your electronic health record and financial systems to produce extremely accurate coding. The benefits are many and you are going to need all the help you can get. These systems doesn't have to replace your professional coders; they just aid them and ensure improved: accuracy, compliance, productivity and consistency.
  • Enlist high quality outsourced coding and auditing support to help you get through the transition period and beyond. Highly-qualified outsourced coders, auditors, and HIM professionals can ensure you will have no disruption to your revenue cycle. These coders have undergone a stringent screening process to verify their skill level, education, experience, and level of professionalism. Most are certified RHIT, RHIA, CCS, CCS-P, CPC or CPC-H.
  • Test, Test, Test.  Begin your ICD-10 readiness testing as soon as possible and continue your testing right up to October 1. 

Tags: ICD-10, Best Practices

Uninsured Rate Dips Below 10%

Posted on Thu, Aug 13, 2015 @ 12:30 PM

By Nitin Thakor, President & CEO

I read with interest this week an article In Modern Healthcare’s e-newsletter titled, “Uninsured rate dips below 10%.” The statistic comes from The Centers for Disease Control and Prevention.

In my opinion the most important sentence in the article follows: “The survey also found that 36% of people younger than 65 were enrolled in a high-deductible health plan in the beginning of 2015.”

The growing number of people – not only the young -- who are opting into these high deductible plans is forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes. Shifting payment models, new regulations and healthcare reform are forcing healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.

GeBBS Healthcare Solutions

Most hospital CFOs and group practice managers have no choice but to look for the next generation of RCM solutions in order to keep their organizations solvent. Reimbursement challenges and coping with increased high self-pay volumes have driven many marginally performing healthcare organizations to the brink.

Other changes such as reduced reimbursements, payment reforms, accountable care organizations (ACO), ICD-10 coding transition activities, physician practice acquisitions, as well as the increased self-pay collection costs will all contribute to overall declining margins.

Not only will physicians and hospitals be swamped by treating this new wave of patients, their infusion into the healthcare system is going to create significant financial challenges due to many of the newly insured patients having extremely high deductible insurance plans, forcing hospitals and physician groups to collect this money on their own. According to a Kaiser Health News report, out-of-pocket payment amounts under the Affordable Care Act (ACA) will range from $6,350 for individuals to $12,700 for families.

This new pressure on healthcare providers’ revenue cycles is not going away; it’s something everyone will face soon.

Tags: ICD-10, Business Process Outsourcing (BPO), Revenue Cycle Management (RCM)

Dual Coding Could Minimize ICD-10’s Impact on Revenue

Posted on Tue, Jul 28, 2015 @ 07:00 AM

 

11236638-medical-codingDual 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.

These systems do not replace your professional coders; they just aid them and ensure improvement: accuracy, compliance, productivity and consistency, while your facility is “getting up to speed” on the new ICD-10 codes.

CAC combines expert workflow technologies, rules-based automation, and certified coders to guarantee accuracy rates of over 95%. CAC features include:

     • Works with all input formats (including HL7, Doc, PDF and TIF, scanned paper reports)

     • Works across all medical specialties

     • 95%+ accuracy

     • 24 hours turnaround time

     • No implementation costs

Dual coding using CAC technology will allow you to:

  1. Analyze your provider documentation and identify areas of risk, offering a clear picture of which providers require additional education, and which providers could serve as physician champions
  2. Assess the quality of your ICD-10 coding, which will enable you to identify the need for, and implement needed education
  3. Provide real time data and explicit direction to the clinical documentation improvement (CDI) staff
  4. Conduct time studies enabling HIM professionals to better prepare for their specific organizational needs through analysis of real time data and actual productivity metrics, rather than planning needed ICD-10 go-live support based on  artificial data
  5. Test claims with insurance carriers, providing opportunity to identify and correct claim submission errors prior ICD-10 go-live

Some CAC technologies come with secure cloud-based auditing systems that work in conjunction with your EHR and coding platforms to provide complete medical record auditing that optimizes and accelerates your coding audit process.

Dual coding using CAC also enables financial modeling to determine how certain diagnosis-related groups (DRGs) might be weighted differently, how the new codes will affect reimbursement levels, and what edits may be required. This provides insights into the impact on net revenue or where additional or more comprehensive documentation will be required.

Tags: ICD-10, Best Practices

Healthcare Financial Professionals Seek New Ways to Rescue Revenue Cycle Management

Posted on Mon, Oct 06, 2014 @ 10:59 AM

Business pressures are forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes. Shifting payment models, new regulations and healthcare reform are forcingHealthcare Financials healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.

Most hospital CFOs and group practice managers have no choice but to look for next generation of RCM solutions in order to keep their organizations solvent. Reimbursement challenges and coping with increased self-pay volumes have driven many marginally performing healthcare organizations to the brink.

In 2014, it is predicted that changes, such as reduced reimbursements, payment reforms, accountable care organizations (ACO), ICD-10 coding transition activities, physician practice acquisitions and increased self-pay collection costs will all contribute to overall declining margins. The increase in self-pay accounts will be significant, driven the Affordable Care Act (ACA) which is going to send a huge number of newly insured patients into the healthcare delivery system. Under ACA, every U.S. citizen is required to have some form of medical insurance, or pay an opt-out fine.

Not only will physicians and hospitals be swamped by treating this new wave of patients, their infusion into the healthcare system is going to create significant financial challenges due to many of the newly insured patients having extremely high deductible insurance plans, forcing hospitals and physician groups to collect this money on their own. According to a January 2014 article in Kaiser Health News, out-of-pocket payment amounts under the ACA will range from $6,350 for individuals to $12,700 for families.

This new pressure on healthcare providers’ revenue cycles is not going away; it’s something everyone will face soon.

Tags: ICD-10, Revenue Cycle Management (RCM), Healthcare Revenue Billing, Accounts Receivable (A/R), Accountable Care Organizations (ACOs), Affordable Care Act

Healthcare Financial Professionals Seek New Ways to Rescue Revenue Cycle Management

Posted on Mon, Oct 06, 2014 @ 10:29 AM

Business pressures are forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes.Shifting payment models, new regulations and healthcare reform are forcing healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.

Most hospital CFOs and group practice managers have no choice but to look for next generation of RCM solutions in order to keep their organizations solvent. Reimbursement challenges and coping with increased self-pay volumes have driven many marginally performing healthcare organizations to the brink.

In 2014, it is predicted that changes, such as reduced reimbursements, payment reforms, accountable care organizations (ACO), ICD-10 coding transition activities, physician practice acquisitions and increased self-pay collection costs will all contribute to overall declining margins. The increase in self-pay accounts will be significant, driven the Affordable Care Act (ACA) which is going to send a huge number of newly insured patients into the healthcare delivery system. Under ACA, every U.S. citizen is required to have some form of medical insurance, or pay an opt-out fine.

Not only will physicians and hospitals be swamped by treating this new wave of patients, their infusion into the healthcare system is going to create significant financial challenges due to many of the newly insured patients having extremely high deductible insurance plans, forcing hospitals and physician groups to collect this money on their own. According to a January 2014 article in Kaiser Health News, out-of-pocket payment amounts under the ACA will range from $6,350 for individuals to $12,700 for families.

This new pressure on healthcare providers’ revenue cycles is not going away; it’s something everyone will face soon.

Tags: ICD-10, Revenue Cycle Management (RCM), Accountable Care Organizations (ACOs), Affordable Care Act, Insurance Billing Solutions

10 Steps for ICD-10 Readiness You Must Know

Posted on Tue, Jul 08, 2014 @ 09:48 AM

There have been numerous delays to the implementation of ICD-10. These delays have causeddescribe the image untold frustration, -- but they have also created opportunities for healthcare providers and the organization that serve the healthcare industry. You now have time to readjust your ICD-10 timeline preparations. As an HIM Director for many years, I am offering a plan of action that may help you be prepared for the October 2015 deadline.

Considerations for Your ICD-10 Preparation Timeline

First, don’t stop or delay your planning and preparations. You have probably already accomplished some of the tasks required to meet the transition to ICD-10.  Stay the course; keep on preparing and simply be ready early – in 2015.  

Here’s a brief outline of my plan. If you would like the complete details of this my plan, please click on the button at the end of this blog. There are a myriad of steps under each of the following major headings that you need to take to be prepared.

Outline for ICD-10 Preparations

  1. Organize YOUR ICD-10 Efforts
  2. Assess the Impact ICD-10 Will Have on Your Organization
  3. Conduct Vendor Assessments for the Support You Will Needs
  4. Contact Billing Services and Clearinghouses to Assess their Preparedness
  5. Assess Your Training Requirements
  6. Revise Internal Processes as Necessary
  7. Identify Your External Testing Needs and Dates
  8. Conduct a Risk Assessment for Areas that May Present Challenges
  9. Implement ICD-10 Coding in Your Workflow
  10. Monitor Your Accuracy – Audit, Audit, Audit

A good preparation plan will significantly reduce your risks. Any transition of this magnitude will present a huge risk to your organization. Misapplication of the new coding not only threatens lost income but an assortment of other administrative and even legal issues.  Use this new delay in the compliance date to reassess your plan and ensure that everyone in your organization is prepared.

Adopt new technologies where needed. Obsolescent technology is a burden for any healthcare organizations, and will even be more critical during the transitions to ICD-10 Technology has a short lifespan and new technologies, such as computer-assisted coding (CAC) are being perfected every day. There are also staff support services that can augment your staff’s expertise during this transition. Avail yourself to every possible avenue of assistance during the transition, and most importantly – BE PREPARED!

For my complete plan click here.

 

Let's Talk About ICD-10

 

- Stacy Swartz, RHIA, CCS, CPC 

Tags: ICD-10, Health Information Management (HIM)

The Importance of Physician Champions in the Transition to ICD-10

Posted on Wed, Jun 11, 2014 @ 11:20 AM

Do you have a "physician champion"? You should. A physician champion who will support your clinical documentation improvement (CDI) program and communicate the importance of an

integratedcare

ICD-10 CDI program to his or her peers will go a long way in ensuring the success of your transition to ICD-10 in October of 2015.

Providers are now keenly aware of the ICD-10 billing requirements for claims beginning October 1, 2015. There has been, and rightly so, significant concern within the healthcare industry about the financial risks that will be incurred in the transition process, including the fact that utilization of the wrong code may result in reduced reimbursement or total rejection of a claim. Some have called this change the biggest challenge to face healthcare providers since Medicare came into being in the 1960s.

Much has been written about how to prepare for ICD-10. The emphasis has been on training the medical billing staffs and coders on how to make the transition from the 13,000 ICD-9 codes to the 69,000 ICD-10 codes. Unfortunately, there hasn’t been as much time spent or resources expended on physician education and support for the upcoming conversion. Physicians need to understand how important it is for them to properly document their care in order for coders and billers to be able to fulfill their important roles in the new billing scheme.

A report in the May 10, 2014 HIT Consultant e-Newsletter stated that 44 percent of physicians were uncertain whether or not they would have been ready for the October 2014 deadline, according to the 2014 Practice Profitability Index (PPI). In fact, another 25 percent were certain they would not have been prepared to face the transition and the ICD-10 upgrade costs.

Hospitals and medical practice groups of all sizes should be focusing on physicians and their documentation of patient care as a major aspect of how to prepare for ICD-10. Experts recommend that each healthcare entity select an ICD-10 champion from within their current staff. If possible, there should be a champion from each specialty area in a multi-specialty practice or a hospital’s medical staff in order to concentrate on how to prepare for ICD-10 within that specific area of medicine. 

Champions should be trained in the codes for their specialty area and documentation requirements to support the billing codes. They need to be willing to convey to their peers thevalue of the documentation and how it relates to proper reimbursement.

Physicians respond best when other physicians are the ones educating them on how to improve their documentation.  They are not interested in codes, but are primarily interested in providing the highest level of patient care possible. Champions can convey to their peers the connection between ICD-10 codes and how more specific documentation can improve patient care. With emphasis on patient care instead of coding, physicians will be more receptive to the change.

Champions can increase motivation of providers by emphasizing the positives of the new system, including more timely and accurate payments, fewer claim denials or returns for more information and improved patient care based on the documentation. A physician champion can engage their peers into viewing the new ICD-10 codes as management tools for improving patient care, instead of simply a burdensome bureaucratic requirement for getting paid.

Having a physician champion on your ICD-10 team will make your transition efforts easier and more successful.

Tags: ICD-10, Clinical Documentation Improvement (CDI)

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