HTC's ICD10 solutions for RCM
According to CMS mandate, from October 1 2014 ICD 9 code sets will be replaced by ICD10 code sets. Many healthcare providers are facing a tough transition to the new ICD10 code sets. This massive overhaul of the national coding system, going from roughly 17,000 codes to about 140,000, will be the most significant change to health care in decades.
While EMR/ EHR and Practice management software vendors may have addressed some aspects of ICD10, migration to the new code set is not just about installing a new EMR or EHR package. There is an estimated 4%-6% loss in revenue due to the transition for most Providers.
Converting to ICD10 will impact almost every aspect of a provider's operations, including patient services, care delivery, revenue cycle management, data analysis and reporting, as well as a number of information technology (IT) systems that use diagnostic and procedural information.
HTC realizes that one critical operation that requires close attention is healthcare provider's Revenue Cycle Management which includes medical coding, billing, insurance claims processing and accounts receivable management.
HTC offers services to support the transition to ICD10 specifically in the Revenue Cycle Management processes including Medical coding (including Clinical documentation template re-designs), Contract management, charge capture and Billing and Reimbursement, A/R management and Payment posting.
Analytics to predict ICD10 Revenue loss
Predictive analytics is an advanced business intelligence concept that can help healthcare providers mine existing data for trends and patterns in reimbursement and denials resulting in high-value, actionable improvements for their Revenue Cycle.
It uses a rule-based technology to identify root causes and trends causing missing charges or underpaid claims and their correlation across different Payers and diagnoses.
HTC can help in creating and implementing an algorithm based predictive model using Big Data analytics tools such as Hadoop, Mark Logic etc.
HTC also offers value added services such as Reimbursement analytics to further adjust Clinical document templates to improve reimbursement rates and reduction in Claim denials.
Reducing Reimbursement Timeline
It is anticipated that one of the most common reasons for Claim denials post ICD10 go-live will be insufficient data in clinical documentation. Many healthcare providers use manual processes for addressing queries raised by coders to Physicians. The unanswered physician queries and extended response cycles affect the reimbursement timeline and eventually result in revenue loss. Further, there is no way to track and report on response rates and associated financial impact.
HTC's physician query tool allows the coder to reference and annotate the Clinical document/ Claim form to the Clinical documentation specialist.
The queries are routed to the appropriate Physician for additional information. Once the physician provides the additional clarifications / documentation, the coder updates the information and submits the Claim. This enhanced collaboration and tracking, reduces the time taken for response, improves clinical documentation process, improves accuracy of coding and provides a quick turnaround time for the Payment.
A near term goal for most healthcare providers is achieving financial neutrality i.e., minimizing or eliminating the risk to the revenue cycle. Analytics helps providers to focus on identifying high-impact, high frequency ICD 10 codes, and track key performance indicators such as Discharged But Not Final Billed [DNFB], accounts receivable days and others.
HTC can help you in combining financial and clinical outcomes for measuring and controlling RCM process and take necessary actions to achieve financial neutrality.
HTC offers ICD10 solutions for RCM