ICD-10 is here in full force, and many providers are already feeling the effects. Slowdowns and the anticipation of the first round of claims denials have many providers biting their nails hoping that they can somehow come back up to speed.
While a rocky ICD-10 implementation transition should be expected as your organization irons out the kinks, there are still many strategies you can employ to eliminate pain points, avoid claims denials and speed up your RCM processes in general. Here are a few suggestions that can revamp your RCM efforts and improve reimbursements overall:
1. Invest in Training
The coding procedures of ICD-10 are much more complex and intensive than the legacy ICD-9 system before it. While there were around 13,000 codes in ICD-9, ICD-10 has 68,000. Merely trying to translate ICD-9 to ICD-10 simply will not work because of the incredible new levels of nuance and complexity afforded by the ICD-10 coding system.
Train everyone in RCM on the ICD-10 procedures for claims, appeals and obtaining guidance from the CMS. Every employee should have at least cursory knowledge of the general theory and practice behind ICD-10 coding, and senior staff must have a definitive working knowledge of the coding procedures. With these knowledge leaders in place, your RCM staff can have someone to consult when they get confused about what they need to do next rather than throwing up their arms in frustration.
2. Appoint New Positions
One of the best ways to streamline RCM may seem like it adds more blockage to the workflow, but in the end it will help reduce setbacks that keep claims in billing for too many days or have reimbursement requests denied repeatedly.
Namely: hiring or appointing new staff positions. Having someone audit all claims before they are submitted helps ensure a lower incidence of denial. Having another person or group of people handle every denied claim and enact a dedicated appeals procedure helps prevent taking work power away from filing incoming claims from billing. The team that handles denied claims can also inform training processes down the road so that common mistakes are addressed. Read more