October 12th, 2012

Maximizing Revenue for ICD-10: Steps Practice Managers Should Follow

By Ken Bradley

The healthcare industry’s conversion to ICD-10 codes involves changes that could impact reimbursement for practices significantly. Not only will the transition require practices to consider the technical complexity of the conversion, but they will also need to understand how it will affect each department of their organization. As a result, maximizing revenue streams under ICD-10 will require a strategic and multi-pronged approach.

In a fairly recent Healthcare Payer News article titled, “5 keys to a positive financial impact of ICD-10,” the author notes that a proactive and candid evaluation of current deficits in clinical documentation and coding—and subsequent adjustments for ICD-10—could make all the difference.

The ICD-10 implementation delay offers a great chance to examine ways to improve clinical documentation. While some may think clinical documentation has little do to with revenue, I’d contend that it will have everything to do with revenue down the road. The greater precision of ICD-10 means that practices will be able to better demonstrate patient outcomes—a key factor in pay-for-performance reimbursement models. However, that can only happen if clinical documentation is solid enough to support the greater specificity of ICD-10 codes.

After working to improve clinical documentation, there are several other things practices and healthcare organizations can do to ensure minimal disruption to their revenue cycles during the transition:

• Negotiate payer contracts based on ICD-10 codes. ICD-10’s greater accuracy can help practices better understand their reimbursement—and in turn better negotiate with payers. A reduced need to use “unlisted” diagnoses, for instance, would mean far fewer instances of negotiating reimbursement on a claim-by-claim basis. By the same token, the improved coding can improve your grasp of what it costs to provide particular services to certain patient populations—critical knowledge for succeeding under accountable care.

• Anticipate a streamlined claims process. Under ICD-10 there should be less need for supporting documentation and electronic attachments to claims. That should speed up payments, resulting in fewer rejected claims and lower administrative costs.

• Embrace ICD-10 as a quality, safety and patient-satisfaction initiative. Ultimately, the ICD-10 specificity should benefit your patients by allowing the capture of new, more detailed data to enhance patient safety and outcomes. Healthier and happier patients also translate to better provider satisfaction scores—another vital component for doing well under performance-based reimbursement models.

Viewing ICD-10 as an opportunity, not as a burden, is the best attitude to have about the ICD-10 transition. While it literally requires learning a complex new language, practices that learn to speak it well will be better positioned for revenue success.

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