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Healthcare organizations anticipated that a transition from ICD-9 to the updated ICD-10 coding standard October 1, 2015, would require massive preparation—dedicated staff education, detailed technology advances that would ensure correct code selection and translation, and dual coding and testing—all in an effort to circumvent billing and coding disruptions. Yet even the most meticulous planning does not always preclude unforeseen obstacles from surfacing. And, for that very reason, effective preparedness must include a contingency plan—what to do when things don’t go as projected.
What’s your rapid response plan?
As has been gleaned from the experiences of our healthcare counterparts in Canada and elsewhere, the ICD-9 to ICD-10 crossover will not be without effect. It would be risky to assume otherwise. After all, ICD-9 has been the coding standard for thirty years. Notwithstanding the inevitable considerations related to the loss of productivity, the other unknown outcomes, should they lead to even moderate disruptions in your revenue cycle, could be dire. The downstream working capital and cash flow impact could have weighty ramifications. Considering the need and seriousness of an effective ICD-10-issues response mechanism is an operation’s best practice. Having the plan in place and poised to execute in the time of need avoids adhoc attempts to quell the problems during times of distress.
Questions that should be considered:
- Will the response be swift, efficient, and robust enough to not only address the problem, but lessen the likelihood of repeated issues?
- Have the offsetting compromises and opportunity costs been realistically weighed?
- Knowing that the response will be in the context of an ever-changing environment, are there other disruptive elements that may be triggered and considered?
Feeling a bit unsteady?
You are not alone. Healthcare organizations of all types are facing the same operational and informational uncertainty. Will interfaces, billing systems, clearing houses, payers, and new technology work together seamlessly? What about data quality—does enough information exist on clinical records to support the detailed classification? Will you be able to report data timely given incomparable codes and groupings? Can your organization weather a revenue cycle disruption? And what happens when the answers to these questions is “no,” but you need an immediate “yes?”
What are your options?
Tackling a revenue cycle disruption on your own may prove risky and replete with a number of challenges—each inevitably wasting additional time and guaranteeing prolonged working capital impact:
- The cost of redeploying existing personnel to identify new and foreign issues, while diverting precious resources from other job responsibilities.
- The impact on your organization’s critical revenue-hinged timeline with a potentially inefficient trial-and-error process.
- The potential layering of additional fixed costs created by a need to hire additional personnel.
Prefer to have a low-risk and more viable response mechanism in place?
PYA’s Rapid Response and Recovery Team™ is ready with the remedy! Ranked as the 9thlargest privately owned healthcare consulting firm in the U.S., PYA is poised to help organizations by deploying objective, experienced, highly trained personnel who focus solely on timely, efficient resolutions to lessen the impact of depleting working capital and cash flow. Most importantly, PYA’s team is a variable cost alternative; it is an expense that is incurred only if, and when, needed. PYA’s team can quickly help establish best practices for the organization going forward, eliminating reliance on trial-and-error initiatives that can pose greater risks to organizations and exacerbate a higher stress environment. In addition, PYA provides solutions that include:
- Analyzing claim and rejection reports to identify issues before claims are submitted.
- Quickly identifying root causes of denials to prevent continuation.
- Working with billing/claim processing software vendors and clearing houses to determine appropriate claims sent and received.
- Providing expert training resources for staff, and addressing issues preventing claims from being paid.