Every one of us has come face to face with the conundrum of speed versus accuracy. Do you tend to work quickly, thus ensuring completion of the task at hand, or do you maintain a more cautious pace that pays off with greater accuracy? In the typical environment where providers treat more patients and more complex cases, either choice can feel like a tradeoff.
Since Oct. 1, the ICD-10 transition has put even more pressure on healthcare teams, from clinicians to front-office and revenue cycle staff. Especially during these initial months following the ICD-10 launch, providers must strive to avoid two types of ICD-10 errors. First, they must pay careful attention to coding, ensuring it matches clinical documentation and meets specificity requirements. Second, they must do their best to avoid any coding errors, such as selecting inaccurate codes or not meeting medical necessity requirements. These errors can impede cash flow for weeks or even months. As the healthcare industry adapts to ICD-10, five steps can help providers achieve greater accuracy:
- Foster the right environment. The stress and anxiety that naturally accompany change will already have teams on edge, which can lead to errors. By establishing the expectations that ICD-10 isn’t a race, and staff won’t be expected to keep the same pace as they did with ICD-9, leadership can foster an environment where accuracy trumps speed. Encourage team members to take time as needed to ask questions, check each other’s work, and simply focus on getting things done the right way the first time. Tell coders and physicians you know queries will increase; you’d rather have them spend the extra time to ensure clinical documentation is not only accurate but also meets specificity requirements. Allowing for minor delays now can safeguard against serious payment delays later. As everyone becomes more comfortable with ICD-10, speed will follow.
- Ask your clearinghouse for support. Clearinghouses have a better vantage point for spotting common problems that can impact cashflow. Ask whether your clearinghouse has aggregated rejections over its entire client base to pinpoint typical problems. If your clearinghouse sends regular and as-needed reports to update clients regarding payer issues, make sure team members are on these distribution lists.
- Pay close attention to front-end processes. During a period when claims-related productivity is slower, patient collections can generate much-needed revenue. If you haven’t done so already, adopting a proactive strategy for reviewing patient estimates and collecting at time of service can help ensure your organization’s financial health. Involve front-end staff in reducing rejections and denials by creating a team that reviews reasons for rejections and denials, and implements ways to potentially eliminate those caused by office staff.
- Have a financial safety net. As the United States continues to recover from one of its worst economic recessions, providers are under great pressure to sustain their financial health and, in some cases, simply make payroll. Having a line of credit or other financial safety net can give you peace of mind during the initial weeks of the transition. Even if your organization has implemented a thorough ICD-10 transition plan, certain factors are out of your control. For instance, if a large percentage of your claims comes from a certain payer that has problems, your cashflow may suffer.
- Measure your way to success. If payers identify errors and issue denials during their first adjudication, they can shorten providers’ payment delays. In this scenario, however, providers aren’t told about recurring problems and won’t be aware of trends in inaccuracies. Such systemic issues can lead to greater, long-term revenue problems that occur when mistakes are repeated and should be circumvented as quickly as possible. If you don’t regularly track revenue cycle key performance indicators (KPIs) such as denials, rejections, and A/R by payer, it’s a great time to start. You’ll be in a much better position to know exactly how the transition is impacting your practice’s financial health, and you’ll identify problem areas much more quickly.
It may be tempting to push your team to submit claims at a pace close to the one they maintained with ICD-9. During the initial months of ICD-10, however, this goal may be unrealistic and can create a stressful environment where accuracy suffers. In the overall scheme of your organization’s tenure, it’s a relatively short length of time to allow for adjustment to the new coding system. As our industry learns to speak this complex new language, teamwork and patience can help providers weather the pressures and reap ICD-10’s benefits.
