Tips revenue drop icd 10 transition

Tips for Addressing Unexpected Revenue Drop Following ICD-10 Transition

This article gives some effective tips to effectively address revenue drops while transitioning to ICD-10

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Though ICD-10 medical coding has gained momentum since October 1, 2015, the concerns regarding practice revenue still remain. Before the compliance date, many industry experts predicted a sudden revenue drop just after the ICD-10 implementation and recommended several tips for effective transition. However, the Centers for Medicare and Medicaid Services (CMS) said the number of claims submitted held steady after the first month of transition and there was no significant increase in claim rejections. Even so, industry experts warn that it is very important for healthcare providers to keep an eye on their reimbursements and watch for any unexpected revenue drop in the coming months. So, you should identify and fix any glitches within your processes or workflow before it impacts your bottom line. Here are some effective tips for that.

Review Frequently Used Codes Apart from monitoring the overall claim denials, you should also regularly review the codes that you bill most frequently (the top 10 codes). Since those codes are associated with the services that form the biggest part of your revenue share, denials of claims that use these codes will have a significant impact on your practice revenue. In addition to that, you should run separate reports on your highest-volume payers in order to understand the trends in denials.

Keep Track of Your A/R You should carefully monitor your accounts receivable (A/R) to effectively address any unexpected revenue drop. Review your A/R every week instead of on a monthly basis. Most practices give priority for getting claims paid before looking into pending or denied claims.

However, if you address the denials as soon as they come in, you can avoid repeating potentially costly errors.

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Don’t Depend Too Much on Medicare Grace Period Healthcare providers have the chance to make adjustments with Medicare announcing it won’t reject claims solely based on unspecified coding during the first year of transition. However, it is better not to wait for that enforcement to kick in to get your documentation in order. Lay a solid foundation with relevant changes in workflow, specific documentation and establishing processes in place for monitoring and responding to spikes in activity. After that, you can take advantage of Medicare grace period to resolve minor glitches.

Detailed Coding It is very important for physicians to include enough detail in their documentation for the coders to make an appropriate assessment, especially when ICD-10 is too specific in nature. If no proper information is available, the coders may be required to go back to the providers continually for more information which will cause delay in claim processing and reimbursement.

You can minimize such delays by taking the following actions. 

Avoid overuse of unspecified codes or simply have sufficient documentation that helps to choose the most appropriate codes.

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Instead of relying too much on EHRs, customize medical coding according to your specialty.

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Improve the communication between physicians and coders so that physicians can understand the level of documentation required for filing claims and coders can avoid going back to physicians frequently and thus save their time.

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Schedule Audits Audit your coding on a regular basis to identify and fix glitches very early. You can schedule audits every three months also to assess the accuracy and specificity of both coding and documentation.

If you find that you are getting more denials due to invalid or unspecified coding or not meeting medical necessity, sort and track them to get an idea about the real cause of denial. Don’t hesitate to take help from a professional medical billing and coding company, if you find it too difficult to handle the entire process and it is affecting the quality of care.

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800-670-2809