Updated on: November 21, 2016

Fine-Tuning for Financial Success During the ICD-10 Transition: Preparations to Prevent Cash Flow Disruption

By Ken Bradley
Original story posted on: July 19, 2015

When something needs fine-tuning, it’s either near the end of preparation (“Hey, let’s fine-tune the presentation before tomorrow’s meeting”) or in pretty good shape overall (“Fortunately, that squeak is no big deal; your car just needs fine-tuning”). For most providers, both scenarios are likely an accurate reflection of their ICD-10 status.

After months of hard work, the finish line is in view—a fact that elicits relief alongside a healthy dose of stress as everyone asks, “Will we be ready on October 1? What are our weak points?” And lastly, the question top of mind for leadership: “Can we do anything else to protect our cash flow?”

Despite the short timeframe until October 1, providers can take additional steps to safeguard against cash flow disruption and revenue loss by fine-tuning two distinct areas. The first is the ICD-10 plan itself, which may have new issues or gaps that weren’t apparent earlier in the planning stages. The second is overall revenue cycle management (RCM), or more specifically several key functions that contribute to its success and can also pave the way for a smoother ICD-10 transition.

Fine-Tuning the ICD-10 Plan 

During the final weeks of preparation, healthcare leadership can benefit from assessing the ICD-10 plan itself and the progress of each component. With so many varied initiatives from vendor updates to physician training, it can be easy to misjudge the status of an important task or overlook something altogether.

This assessment should be both thorough and specific; if your team has been using a formal list that details each ICD-10 project and milestones, you already have what you need. If you haven’t followed a comprehensive plan that details all initiatives, the ICD-10 Hub offers a helpful checklist to guide organizations in the transition to ICD-10. Other organizations such as American Health Information Management Association (AHIMA) and Centers for Medicare and Medicaid Services (CMS) also offer project plans, giving you diverse options to meet your needs.

Even if you’re attuned to your organization’s preparations, the visual aspect of reviewing the status of every component in black and white can reveal dependencies and risks, and support fact-driven decisions about how your team should use its remaining preparation time. After identifying areas in need of attention, you’ll be able to adjust priorities as needed or develop contingency plans to safeguard against issues that can impede revenue.


Fine-Tuning Key RCM Components

Many aspects of revenue cycle management (RCM) are tightly linked to ICD-10. That’s why fine-tuning certain back office and RCM processes can have a big pay-off in October. These changes can facilitate overall RCM optimization; therefore, they’ll be a catalyst for improvements long after providers have adjusted to ICD-10:

  1. Patient Payment - Traditionally, the processes for patient collections and claims management have been extremely connected, with providers sending statements after payers reimbursed the claims. Denial rates are sure to increase after October 1, so providers can truly benefit from separating the two functions. By generating patient estimates and requesting payment at time of care rather than waiting for claims payment, providers can substantially accelerate cash flow - and mitigate risks associated with both delays and denials.

  2. Coding - During the first weeks of the ICD-10 transition, coding could easily create significant bottlenecks that impede claims payment. Faced with the real-life scenario of selecting the most accurate code to reflect the clinical documentation, coders may be cautious and take longer than anticipated. Even if your organization is ahead of the game and has conducted practice runs for coders, the pressures that accompany go-live can cause errors or delays. Consider providing tools coders can incorporate into their repertoire to provide clarity and support throughout the ICD-10 transition. E-codebooks and online communities, for instance, can help coders right at their desktop with little to no disruption to their workflow. Now is a great time to implement these tools, as coders can become accustomed to using them before October 1. Lastly, if your coders aren’t ICD-10-certified, it’s not too late to start this process. The certification will allow your coders to fine-tune their own coding, reinforce critical knowledge and make continuous improvements.

  3. Clinical Documentation - It’s not exactly a revenue cycle process, but clinical documentation is the foundation of all subsequent tasks such as coding and claims submission. If clinical documentation isn’t accurate or doesn’t meet ICD-10 standards, it will impede every following step and hinder cash flow. Schedule some final reviews of clinical documentation standards with physicians. Review past chart audits and see if physicians need additional training for any frequently used diagnoses. During this time, you can also gauge physicians’ comfort level with vendor updates. Determine if any fine-tuning can improve EMR templates and make physicians’ tasks easier or more user friendly. If physicians are comfortable with the new documentation standards and updated technology, their sense of confidence and preparedness will be infectious.

Easing Pressure and Providing Support

Especially when related to team preparation, fine-tuning frequently enables greater confidence and cohesiveness. Because ICD-10 impacts nearly every department and process, this confidence and cohesiveness is particularly important. As you’re reviewing ICD-10 status with various staff, inquire how certain negative scenarios would impact their daily tasks and objectives. For instance, ask back office staff to pretend they have to handle 50 percent more denials. How would they cope? Their responses can reveal individual and team weaknesses and what contingency plans are necessary.

Lastly, boosting your team’s confidence can ease nerves and enable a smoother ICD-10 transition. Undoubtedly, the best way to increase confidence is through preparedness, but leadership’s support and positive outlook are also invaluable.

Months after organizations have adjusted to ICD-10, team collaboration and RCM improvements can enable long-term financial success, and remind all of us that all the hard work was very worthwhile.

About the Author

Ken Bradley, vice president of strategic planning and regulatory compliance and one of Navicure's founding members, is responsible for assessing markets, monitoring government regulatory requirements and providing competitive analyses to develop strategies and solutions that ensure Navicure and its clients continued success in an increasingly complicated business environment.

He is responsible for all Navicure industry transitions, including ICD-10 and 5010. He has given educational presentations and written several articles on 5010 and ICD-10.

Contact the Author

Comment on this Article

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.

Related Stories

  • Integrity: The Missing Component in CDI
    Integrity means moving from a retroactive, transactional approach to one that documentations patient care. There is much discussion and movement in the clinical documentation improvement (CDI) industry regarding using the word “integrity” in describing the discipline. In perusing the Internet…
  • ICD-10 Coding: Moderate “Conscious” Sedation vs. “Monitored” Sedation – Are you compliant?
    Coders must ensure documentation supports the service, either moderate sedation or MAC. Coding moderate sedation (or conscious sedation) and monitored anesthesia care (MAC) is not difficult; however, distinguishing what the services provided are and deciphering conflicted information about which physicians…
  • Major Challenges Face Coders in 2019 and Beyond
    Address documentation and coding issues up front, rather than correct them later. Coders have had many challenges throughout the years.  When I started in the industry, we did not submit claims electronically; they were submitted on paper and we used…