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How to Streamline Your Hospital's Collection Process Ahead of ICD-10
Revenue cycle personnel can expect a certain amount of upheaval surrounding the transition from ICD-9 coding to ICD-10 this fall. Only a small percentage of codes map one-to-one from ICD-9 to ICD-10, and ICD-10 has about five times as many possible codes as ICD-9 does. Preparation, training, testing, and implementation will require time and resources, and healthcare providers are understandably concerned.The conversion to ICD-10 coding represents a major change.
Third party payers are big supporters of ICD-10, particularly for inpatient facilities, because the newer system offers greater detail in patient records and can prevent miscommunications between providers and insurers. Their hope is that incorrect classifications will become rarer, and medical records will become better data sources for overall health trends. Streamlining your hospital's collection process ahead of ICD-10 will help the conversion be smoother. Here's how.
Invest in Training for Your Coding Staff
Self-paced training is good, but it's no substitute for dedicated training for your coding and billing staff. To allow for sufficient training, you may have to outsource some coding or bring in temporary workers to assist with the medical accounting process while parts of the coding staff undergo training. Once training is completed, coding staff will need to spend time practicing ICD-10. Again, it may be necessary to add temporary workers to help with workflows in the lead-up and transition to ICD-10.
Make Sure Your Registration Process Pulls Its Weight
From the time a patient books an appointment, your staff can be taking steps to streamline the collection process. Verifying a patient's insurance coverage is essential, as is making a copy of his or her insurance card if it's new. Ideally, you would verify coverage of the service expected and give the patient an estimate of out-of-pocket costs upon registration. Addressing outstanding balances can also be done during the booking and registration process. These simple steps can help minimize the chance of having to writing off balances and make collections easier.
Validate Charges Before Submitting Claims
Claim scrubbing software featuring standard and custom edits can help prevent submission of erroneous claim forms. These systems can do things like detect coding combinations that suggest unbundling, and point out mutually exclusive procedures. If there are questions about medical necessity, they can be followed up on now, instead of after the claim is submitted (and possibly rejected or denied). Preventing rejected claims is often a matter of following up on details, such as ID numbers and patient information, and a few minutes now can save extra work later.
Use Electronic Claim Process and Payment Posting Whenever Possible
The more processes you can accomplish without paper, the better.
The less actual paper your medical accounting staff has to shuffle during the ICD-9 to ICD-10 transfer, the better. Electronic claim submission and payment posting is faster, uses fewer physical resources, and is less prone to misunderstanding, particularly about things like meeting claim submission deadlines. For claims that must be submitted on paper, use of delivery confirmation from the Postal Service can help prevent disputes about whether claims were submitted before deadlines.
Have Plans and Procedures for Claim Rejection and Denial Management
Obviously, preventing claim rejections and denials is preferable to correcting them, so your basic medical accounting processes should include steps to address these potential problems. If rejections and denials suddenly increase, someone should take a closer look to see if there is a pattern to the issue. Maybe a particular insurer has changed its rules, or perhaps a new coder has a high error rate and requires more training. Getting to the root of increases in rejections and denials is the only way to systematically get the revenue cycle back on track.
Conclusion
Just as proper stretching and conditioning before sports can prevent injuries, evaluating and streamlining your collections practices ahead of the ICD-10 transition can prevent serious disruption. Starting from the time a patient books an appointment, and continuing until payment is posted, attention to detail can require you to spend a few extra minutes up front. But by doing so you can prevent more serious, time consuming problems later on.
