The October, 2014 transition from ICD-9 to ICD-10 will bring with it a sweeping round of changes. And in the midst of that evolution, it’s easy to lose track of small but critical differences. The agreements between providers and payers have a huge effect on the financial success of healthcare companies, and they will need to be updated in advance of ICD-10 to avoid loss of revenue and interruption of service. We recommend following these steps.

Maintain Revenue Neutrality

When billing codes change, there is the risk that the revenue earned from various services will increase or decrease due to problems with the methodology. In order to ensure that both payers and providers are billed fairly in the wake of the transition, it is advisable to run tests comparing the old codes with the new. If discrepancies arise, the billing methodology will need to be examined in greater depth.

Refine Your Testing Strategies

In order accurately measure the efficacy of your ICD-10 transition, a battery of tests needs to be put into place. You have likely been making plans already, but your test methodology might not be as sophisticated as it needs to be. Have you established benchmarks for success or failure? Are you following a testing schedule? Is there an absolute threshold that must be reached in order for ICD-10 to be instituted fully, and is there a contingency plan in place if that threshold is not reached?

Examine Your Operations

How will you expedite issues between payers and providers after ICD-10 goes into effect? You need to consider the issues you will face on a daily basis, and at a greater rate due to the scope of ICD-10, and update your payment agreements accordingly.

Plan for Contingencies

No matter how thoroughly you plan in advance of October, issues are bound to arise. For instance, what would you do if claim payment operations failed because of issues having to do with the new codes? The best policy is to build some temporary flexibility into your payment agreements that allows both parties some leeway if the transition is not as smooth as expected. There also needs to be a monitoring system in place that is tasked with spotting issues on both the payment and provider side.

 

As you can see, your payment agreements are going to need a lot of work before ICD-10 goes into effect. It will take both an administrative and a technical effort to ensure no detail is overlooked. Make sure you have the HIM staff you required by working with recruiters at MedPartners HIM.

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