Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Healthcare Practices Fear ICD-10 Reimbursement Code Denials

By Jacqueline DiChiara

- With nearly one week remaining until ICD-10 implementation becomes a reality, are healthcare organizations’ ICD-10 strategies, attitudes, and efforts on track for revenue cycle success? According to a recent national Navicure/Porter Research survey of billing managers, practice executives, and billers and coders, the fear of reimbursement disaster due to ICD-10 coding dilemmas is a major anticipated hindrance affecting current preparation levels and suppressing positive outlooks.

ICD-10 claims disruption implementation

Almost all survey participants (94 percent) expect their denial rates will increase in approximately one week’s time. But only 30 percent claim they have effectively worked to improve denial management processes to ensure a seamless post-ICD-10 transition. The question remains: is ICD-10 revenue cycle optimism a matter of merely putting your head in the sand?

Research additionally confirms 1 in 3 healthcare organizations have not made changes to their revenue cycle as part of ICD-10 preparation efforts. “While some organizations are being proactive in other areas to improve revenue and cash flow, including improving patient collections (34%) and patient price estimation (17%),” confirms Navicure/Porter research, “35 percent have not adjusted their revenue cycle in preparation for ICD-10."

ICD-10 optimism nonetheless resonates among the majority of survey respondents — a reported 85 percent, in fact. However, regarding more “concerning” news, 57 percent state they “aren’t necessarily on track yet.” Nonetheless, 43 percent of healthcare organizations “are on track for implementation,” nearly double from a survey conducted earlier this year.

Although healthcare organizations confirm ICD-10 readiness levels are greater than before, as reported, an earlier Navicure survey stated that nearly sixty percent of physician practices confirmed their greatest ICD-10’s concern is a possible negative future influence on cash flow and revenue.

Recent research additionally confirms those “proactive organizations” say they have prepared their revenue cycle to maintain cash flow consistency once ICD-10 implementation strikes by:

  • Improving patient collections (34%)
  • Improving denial management process (30%)
  • Testing early with payers (19%)
  • Improving patient price estimation (17%)

What might ICD-10’s greatest challenges be once October 1 hits? Healthcare organizations confirm the following top two fears:

  • Increased clinical documentation update and coding requirements (31 percent)
  • Lack of payer preparation resulting in payment disruption (27 percent)

Despite such tangible trepidations, 46 percent of respondents estimate upcoming ICD-10 financial losses of less than 20 percent. Additionally, 80 percent of respondents anticipate productivity loss; 2 in 10 respondents do not expect any loss in productivity. Sixty-one percent say they expect their denial rate to increase anywhere from 11 percent to 40 percent. 

Additionally, it is only the minority of healthcare organizations participating in end-to-end testing experiencing overall positive results, confirms the research. A​s reported, nearly 90 percent of 29,000 test claims were accepted on behalf of the Medicare Fee-For-Service (FFS) testing from the Centers for Medicare & Medicaid Services (CMS).

Navicure and Porter Research confirm it is not too late to prepare for the transition to ICD-10. Accretion of efforts is imperative for readiness come October, they claim. Researchers conclude with the advice to consider ICD-10 as much more than just an annual coding or technology advancement.

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