ICD-10 is both a clinical and revenue cycle challenge, and ensuring that these two critical functions react to the inevitable ICD-10 upheaval in a coordinated fashion is essential.
In many medical groups, the clinical and revenue cycle processes are largely managed independently. And while the clinical and revenue cycle team will often come together around key initiatives, the communication between the two groups is not always coordinated through an established, ongoing process. Which brings us to the transition to ICD-10.
This new, more complex code set has a dramatic impact on clinical operations and significant impact on revenue cycle processes and IT systems as well. By now, medical groups have established their overall ICD-10 plan and the clinical and financial teams understand what they each need to do (or at least they should). If everything goes according to plan, the two processes should function smoothly, but the complexity and invasiveness of ICD-10 is sure to result in unforeseen challenges not too far down the road.
Since many of those issues will overlap the clinical and financial operations and require a coordinated response, having an efficient, cross-functional team that can make quick, coordinated decisions is essential to a smooth transition. It simply makes good business sense to have a strategy in place to deal with the unexpected.
Here are some examples of the types of issues we are seeing in the field:
A provider selects an accepted ICD-10 code(s) in the clinical system, but it’s flagged in the revenue cycle as “not valid for billing,” which will result in a denial unless the situation is quickly corrected. This specific issue needs to be fixed and coding patterns evaluated to determine whether or not this is a frequent issue that requires additional ICD-10 training for select providers.
Another is the testing of charge messages that include both ICD-10 and ICD-9 codes passing from the EMR to the RCM system. While both software products are ICD-10 compliant, the format of the charge message and the location of the additional diagnosis codes within the message is likely different. Testing these transactions and understanding what works, what the issues are, and which group is going to remediate them is essential.
The ICD-10 PMO team should be made up of domain experts with both operational and workflow knowledge, as well as technical/IT experts who understand your organization’s data flow and system configurations. In addition to this deep knowledge and expertise, they must be empowered to make quick decisions, because slow remediation of these types of issues can be very costly.
It is likely appropriate for the team to meet weekly until the middle of September, when it should move to a daily or every-other-day schedule as the intensity of the issues will likely accelerate as the deadline gets closer.
Of course, we want to know what you think. Please share your thoughts and experiences with us in the comments section below.
That’s it for now. We’ll see you next time back here at RCxRules ICD-10.
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