If the potential for ICD-10 to create disruptions throughout the healthcare system were not great enough already, there are growing fears that the new system of medical codes will add troubling complications to the revenue cycle management process.
Professionals involved with revenue cycle management are already scrambling to respond to changes introduced by the Centers for Medicare and Medicaid Services involving expansions of bundled services. This has caused historical payments to drop, meaning that providers are delivering the same level of service but taking in less money for it.
In response, revenue cycle managers are having to direct intense scrutiny towards the contract management system to ensure that no payment goes overlooked. Concurrently, they are having to coordinate with the various departments that have control over costs and payments to stabilize revenue sources.
Another issue complicating their goals is the large number of newly insured patients that have taken advantage of healthcare exchange plans. A number of these patients have deductibles up to $12,000, creating a confusing relationship between the provider and the payer. Efforts to streamline payments become complicated when the final payer is not immediately clear. As a result, hospitals are increasingly trying to improve their front-end patient engagement efforts and encourage upfront collections.
Along with this period of turmoil comes the looming ICD-10 implementation in mid-October. At present, many healthcare professionals, providers, and stakeholders are uncertain of the exact impact ICD-10 will have; and they are desperate for answers. Three scenarios are possible; ICD-10 will be fully implemented, ICD-10 will be implemented with exemptions, or ICD-10 will be delayed. Each one of those potential outcomes could have a huge impact on the revenue cycle management process, and uncertainty is never an asset when it comes to finance.
If there is a silver lining it’s that industry experts believe that those providers with sound revenue cycle management procedures in place already, will be able to adapt to ICD-10 in whatever form it takes. Those who have made solid documentation by doctors and nurses a priority in the past already have a framework in place that can accommodate this new system of procedure codes. Those that don’t will likely feel the impact of the change in a negative way, at a time when revenue cycle management processes are already under stress.
What is clear is that any provider that wants to keep pace with the rapid evolution of healthcare needs to have a great team of health information management professionals. Find the talent you require to build a top HIM team by working with MedPartners.