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

Policy & Regulation News

Navicure Survey Shows ICD-10 Transition Financial Challenges

By Jacqueline DiChiara

- A third ICD-readiness national survey was released on Tuesday via cloud-based healthcare billing and payment solutions provider Navicure in collaboration with Porter Research.

A follow up to prior surveys from April and November 2013, concluding data reports physician practices express optimism regarding their preparedness with revenue cycle changes following the October 1, 2015 ICD-10 transition date.

A decreased staff productivity level of 52 percent within the first three to six months following the transition date — even with a well-trained staff – may result in dangerously slower reimbursement and delayed claims turnaround, says Navicure. Such dilemmas will require additional staffing resources and overtime to reimburse for such loss, the survey demonstrates.

Such summarized findings are perhaps contradictory to February AMA reports of the allegedly anticipated expensive nature of ICD-10 cost estimates.

Navicure reports estimate ICD-10 implementation costs will triple previously reported estimates numbers from a landmark 2008 Nachimson Advisor study which originally projected the following: $83,290 per small practice, $285,195 per medium practice, and $2.7 million per large practice.

2014 AMA estimates include substantially larger costs for a more detailed list of post-implementation expenses than were previously anticipated. These include training expenses, practice assessment, payment distribution testing, payment disruption challenges, and an overall forecasted decline in physician productivity.

In addition, claims denial rates may potentially double within the preliminary stages of ICD-10 coding, AMA/The Centers for Medicare & Medicaid Services reported.

The vast majority of Navicure survey respondents – 59 percent – expressed primary concern with ICD-10’s future influence on cash flow and revenue.

While most – 49 percent – reported they are unaware whether or not they have budgeted for ICD-10, another 29 percent reported they had not actually finalized any budgeting efforts for ICD-10.

Additionally, only 2 percent of participants reported budgeting between $100,000-$199,999.

In response to such findings, Navicure’s Key Action Terms encouraged physician practices to identify and prioritize budgets to increase preparation for post-transition revenue cycle changes.

The October transition date deadline did not financially impact most — fifty-five percent — of respondents. However, 25 percent either reported the deadline had a negative financial impact on their practice, or they were uncertain what the impact’s implications would be defined as.

Forty-one of survey respondents reported the greatest anticipated challenge of transition was a lack of payer readiness.

“End-to-end testing, a top method to determine payer readiness, with payers remains a top priority, although the number who have ‘opted out’ has increased,” Navicure’s report states.

Three different groups of medical professionals responded to Navicure’s survey. More than half of the survey participants were practice administrators or billing managers. The second largest group of survey participants — billers and coders – made up fourteen percent of participants. The rest of the survey participants – practice executives – made up thirteen percent of those surveyed. Out of all the participants, fifty-six percent are from practices with between one and ten providers.

Only 6 percent of respondents stated their practice lacks funding to begin ICD-10 preparation. But, 13 percent stated they “don’t know where to start” regarding preparation.

According to the survey, physician practices report varying degrees of ICD-10 readiness.

Although 21 percent claim they are on track with preparation efforts, 58 percent of practices reported temporarily ceasing ICD-10 implementation efforts when the delay was announced.

Eighty-one percent of those surveyed said they will be ready for the October transition. Sixty-seven percent of participants consider this transition date is finalized and will not be pushed back further.

Navicure plans to sponsor additional surveys throughout the remainder of 2015 to more closely monitor more accurate changes in survey findings as the October 1, 2015 deadline approaches.



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