How RCM optimization can ease ICD-10 transition for ASCs: 3 steps to protect productivity & revenue after Oct. 1
In an ambulatory surgery center's fast-paced, high volume environment, it can be overwhelming to think about all the last minute ICD-10 preparations that have to be made.
With so little time, think about developing an ICD-10 plan with an emphasis on mandatory tasks such as updating your practice management system and electronic health record. Prioritizing such projects can ensure you address the most critical aspects of the transition prior to October 1; however, a broader plan can deliver many advantages in the long term. ICD-10's 140,000 codes, which represent more than a 700 percent increase from ICD-9's 17,000, is a high-impact change by itself. In addition, the transition requires workflow changes from every team member, including physicians, nurses, front office and back office staff. In short, because ICD-10’s scope is so broad, its transition plan should be as well. By expanding the transition plan to optimize key aspects of revenue cycle management (RCM), ASC leaders can avoid many bumps and hiccups inherent in such a drastic change, and as a result avoid productivity losses, sluggish cash flow and decreased revenue.
The value of allocating time and resources for automating RCM
Technically, revenue cycle optimization isn’t a required component of an ICD-10 transition plan; however, the post-October 1 environment can potentially foster claims management problems. Many expect an increase in denials and rejections for a period of time after the ICD-10 transition begins, in addition to an increase in A/R days. These estimates speak to the many areas, for instance, clinical documentation, technology usage, coding and claims management, where providers may see an increase in errors and reduced productivity after October 1 because of the greater specificity and learning curve required. For example, if claims are filed incorrectly, this could lead to a delay in processing from payers and further a delay in overall cash flow within your organization. As a result, any tools, process changes and technology to increase efficiency and circumvent mistakes can have a big pay-off during the initial transition period and beyond.
At this point, the number of working days until Oct. 1 is quickly dwindling; unless technology to automate key revenue cycle processes is already in the works, implementation clearly won’t happen prior to the ICD-10 transition date. Nonetheless, evaluating current processes and determining how to achieve further efficiencies can set improvements in motion and foster benefits long after October 1. Here are three steps ASCs can take to achieve RCM improvements in the midst of the ICD-10 transition:
1. Supercharge claims management by conquering denials and rejections. If denials and rejections cause any problems in your claims submission process now, they have the potential to make claims management slow to a snail’s pace after Oct. 1. Attack denials and rejections by arming yourself with knowledge; categorize them by type, team member and date so you can easily spot trends and know where your problem areas are. If you’re having trouble identifying and understanding your rejections and denials, your clearinghouse should be able to help provide this data and categorize it in a helpful manner. Additionally, if you don’t already use automation for claims submission, denials management and appeals management, you may want to evaluate technology and discuss options with your clearinghouse. Even if you can’t have this automation in place for October 1, you can still set the stage for improvements that will improve reimbursement in the long run, and help your ASC stay financially healthy during your adjustments to ICD-10.
2. Improve the front office to speed and streamline your entire revenue cycle. With an anticipated increase in denials and rejections, it’s important to evaluate your entire revenue cycle and identify any areas that can improve claims management and increase cash flow. Automating eligibility verification and patient cost estimation processes are two front-end improvements that can increase and accelerate revenue in two ways. First, it will decrease claims errors, thus ensuring you’ll have fewer denials and rejections. Second, it will enable staff to generate fast, accurate estimates, which will not only improve productivity, but will also increase patient collections by facilitating payment at point of care. As patient financial responsibility continues to increase, with out-of-pocket expenses rising from $416 billion in 2014 to $608 billion this year, encouraging earlier payment can help sustain your organization’s financial health during the ICD-10 transition and beyond.
3. Keep working on the front office. Consider revamping patient collections, too. When it comes to reimbursement, ASCs are perhaps more challenged than their referring providers, physician practices or hospitals. This creates an even greater need to improve patient payment processes. If patient payments don’t seem closely related to ICD-10, consider whether your patient billing is tied to claims payment. If it is, decoupling these two processes can speed your payment process and ensure billing isn’t bogged down by ICD-10-payer related claims issues. If you collect from patients prior to claims payment, you’ve embraced an important best practice in patient payments. Practices have more options available than ever, such as automated payment plans to ensure timely collections.
With the many challenges ASCs face, having an efficient and automated revenue cycle can go a long way in boosting ICD-10-readiness and further improving the financial health of your organization during the ICD-10 transition and beyond.
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