T-minus 9 months! Are you ready for ICD-10? Are you really ready?
The Health Information Management Systems Society (HIMSS) Annual Conference is being held in Orlando, Florida this year and I would guarantee that the educational sessions on ICD-10 will be packed with healthcare providers seeking the answer to this very question. On the other hand, some providers may feel very confident that their organization is ready for the October 1st change. In fact, being so close to Disney World, they may be singing, “Hakuna Matata” (Disney’s The Lion King song, meaning, “no worries“), through the conference hall thinking that because their organization has performed ICD-10 readiness assessments, developed detailed project plans for implementation and begun the remediation process, they are good to go.
However, before they start hitting any high notes and doing a dance, they should make sure that they have not only taken the necessary steps to fully understand the impact ICD-10 will have on their workflow and documentation practices, but also to their bottom line. Healthcare organizations need to understand that “As part of a holistic risk mitigation strategy, providers must understand and be able to forecast possible changes to cash flow and engage in advanced planning to protect revenue losses before, during, and post ICD-10 conversion1.”
According to results from a poll conducted by firm KPMG, 76 percent of providers have completed an impact assessment for ICD-10 and 72 percent had set aside a budget to prepare for readiness2.
“As October 1st inches closer, healthcare organizations have their work cut out to properly absorb the impact that the new coding will have on their businesses,” said Wayne Cafran, an advisory principal in KPMG’s Healthcare & Life Sciences practice. “A full 50 percent stated that they had yet to estimate the new coding system’s impact on their cash flow. With estimates by those who did measure the impact tallying anywhere from $1 million to more than $15 million, healthcare organizations are in for a rude awakening when they finally realize what the new standards will have on their bottom lines1.”
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Tips to protect your bottom line
ICD-10 implementation is fast approaching, and providers need to take aggressive steps to ensure that their efforts focus on adequately assessing the potential cash flow problems that may arise after October 1. Don’t start panicking just yet. Here are 9 tips, from Beth Mahan, to calm the panic and help mitigate the potential impact to your bottom line1
- Discuss budgeting avenues for additional cash reserves if material delays in payment occur.
- Conduct financial modeling to understand financial implications moving from ICD-9 to ICD-10 and determining the revenue impact by provider or system facility, service line and geography.
- Review managed care contracts to negotiate protective language relevant to reimbursement in the event payment shifts occur that could have a negative impact on your bottom line.
- Engage with your high-volume payers to assess their readiness state to process your claims coded in ICD-10
- Conduct clinical documentation improvement reviews using ICD-10 code set.
- Develop a strategy for coding, billing and claim backlogs to improve cash flow.
- Determine strategy for denials management pre- and post-ICD-10 conversion.
- Assess readiness state of external vendors who support coding, billing, follow up and denials.
- Review audits occurring that may be impacted by compliant use of ICD-10 over time.
If your organization has truly taken the necessary steps to mitigate the risk to its cash flow, then I would recommend that the organization perform an internal audit for ICD-10 implementation and compliance to assure that when October 1st comes you really are set. Taking the aforementioned steps plus this extra step can bring your organization peace of mind and save you big bucks in the long run.
Then when asked, “Are you really ready for ICD-10?” you can really sing, “Hakuna Matata!”
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