ICD-10 analytics provider, Jvion releases guidance on the importance of providers understanding ICD-10 reimbursement risks for professional fee claims.
With the ICD-10 compliance deadline looming, many providers are kicking their programs into high gear. And those segments that have lagged in their timelines, such as physician’s practices, are working to quickly catch up to recommended milestones. While most of the focus on revenue impacts has remained on inpatient facilities, more and more providers are realizing the great value that a professional fee revenue impact analysis can have in mitigating risks and projecting needed cash reserves. These reserves are critical to surviving the anticipated blackout period that will follow the initial conversion to the ICD-10 code set. This 90-day timeframe is expected to decrease incoming revenues while increasing operational costs because of:
- Uncertainty about documentation quality and medical necessity
- The need to rely on experts and outside consultants
- Delayed payments and decreased cash on hand
- A lack of data and feedback from external sources
- Increased stress and workload for provider resources
Jvion—the leader in ICD-10 analytics—recently released guidance on the importance of understanding ICD-10 reimbursement risks for professional fee claims. The eight points released by the firm suggest that providers examine their professional fee claims impacts to:
1. Proactively address medical necessity-based denials arising from unspecified and lesser specific coding in ICD-10
2. Reduce 3rd party physician audits
3. Avoid increased payor scrutiny
4. Enable a more focused and structured program by prioritizing top risk areas
5. Pinpoint ICD-10 financial risks based on billed and paid amounts due to unspecified/codes with complex maps in ICD-9
6. Drive physician engagement
7. Estimate departmental backfill and productivity needs
8. Analyze specific denial codes based on medical necessity and update existing denial management practices accordingly
“The take-home message is this, ‘it isn’t too late to protect your professional fee revenues from ICD-10’,” said Todd. “Many providers are trying to determine just how much cash they will need to float the initial period following the conversion. Having a detailed understanding of revenue risk can help target this number. Just recently, one CFO was able to determine that she needed 200 AR days worth of cash on hand to support her outpatient/ambulatory operations. For many facilities, having that kind of insight can mean the difference between keeping the lights on and turning them off forever.”
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