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

Policy & Regulation News

Revenue Cycle Management a Post-ICD-10 Implementation Focus

2016 may be a big year for revenue cycle management. Healthcare organizations see steady claims denial post-ICD-10 implementation and remain focused on value-based care models.

By Jacqueline DiChiara

- Healthcare organizations are focused on strengthening revenue cycle management processes in a post-ICD-10 environment, according to Porter Research and Navicure’s national ICD-10-centered survey.

ICD-10 implementation revenue cycle management claims denials

As the concluding chapter of a five-part research study, the latest survey attempted to assess general post-ICD-10 transition attitudes and behaviors, said a BusinessWire press release.

The 360 healthcare organizations surveyed confirmed they have experienced either negligible or no staff productivity impact following ICD-10 implementation.

Retaining productivity levels post-October 1 was a key focus as last year came to a close.

"Keep calm on code on!" – one of many popular revenue cycle mantras that seemed to stick. Perhaps it still does.

Ninety-nine percent of healthcare organizations considered themselves ready for the ICD-10 implementation switchover on October 1, 2015, Porter Research and Navicure claimed.

On the flipside, 13 percent of the practice administrators, billing managers, practice executives, and billers and coders surveyed – most working at organizations with between 1 and 10 providers – reportedly observed a recent drop in productivity.

Examining the post-ICD-10 revenue cycle landscape

According to the fifth survey's key findings, claims denial rates are primarily in the clear. Value-based care initiatives reportedly remain a top focus for healthcare organizations for the remainder of the year.

  • Impact on revenue and denial rates. The majority of participants (60%) did not see any impact on monthly revenue following October 1, 2015, and 34 percent have seen revenue decrease by up to 20 percent. Denial rates remained the same for 45 percent of respondents, with nominal increases between 1 and 10 percent for 44 percent of the participants. Eleven percent of participants reported increases between 11 and 40 percent. This compared favorably to prior survey results where 61 percent of respondents expected denial rates to increase by 11 to 40 percent.
  • 2016 priorities. With the ICD-10 transition complete, two-thirds of participants indicated they plan to work on improving overall healthcare revenue cycle management processes in 2016.Other top 2016 focuses include working towards a value-based care model (15%) followed by updating and automating patient collections strategies (9%).

“Navicure is extremely pleased to see the industry ... has successfully transitioned to ICD-10,” said Jim Denny, Navicure’s CEO.

“Our results following October 1 have been very positive,” stated Ken Bradley, Navicure’s Vice President of Strategic Planning and Regulatory Compliance.

“As opposed to 55 percent of the survey respondents who did report an increase in their denial rate, we’ve seen virtually no change in our client’s denial rates. This is a testament to the hard work that healthcare organizations … have done to prepare for ICD-10.”

Connecting the ICD-10 revenue cycle dots

How does such information stack up against the other four Porter Research and Navicure's ICD-10-focused surveys?

For starters, some earlier research confirmed a decreased staff productivity level of 52 percent within the first three to six months following the transition date could potentially result in slow claims reimbursement and delayed claims turnaround. 

A reported 85 percent of healthcare organizations expressed ICD-10 confidence, according to last September’s survey. Nearly a quarter of this 85 percent explained they were “very confident” in their ICD-10 preparation levels.

According to yet another research study, 94 percent of surveyed billing managers, practice executives, and billers and coders anticipated increases in their denial rates within the first week of October.

Thirty-five percent of surveyed healthcare organizations reportedly did not execute revenue cycle changes as part of their ICD-10 preparation efforts.

The most proactive healthcare organizations, however, were allegedly focused most on improving patient collections, strengthening their denial management process, testing early with payers, and improving patient price estimation efforts.

In closing, the world most thankfully did not end with the ICD-10 switchover. In the words of AHIMA, "Keep calm and code on!"

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