Drg Coding Guidelines

ICD-10 revenue neutrality: 9 ways to protect your cash flow

Though a year of change, it is inarguably a year of opportunity that will markedly improve the classification of morbidity data, indexing of patient records, patient care review, basic health statistics and research. The transition from ICD-9 to ICD-10 offers enormous opportunities for improving documentation processes for health records — especially the EHR.

ICD-10 provides refinement to financial/reimbursement models; it will improve clinical specificity results in improvements to patient safety functions; and it will improve understanding of disease and costs and allows providers and others to improve on their delivery. The ICD-10 code sets are not a simple update of ICD-9. The ICD-10 code sets have fundamental changes in structure and concepts that make them very different from ICD-9, and payments based on ICD-10 must be within an understandable and acceptable variance for both payers and their trading partners.

[Q&A: HIPAA 5010 and ICD-10 from a software vendor's perspective .]

Providers are typically challenged to do more with less — working to maximize cash flow opportunities during normal operating cycles, let alone in one leading up to a transition of this magnitude. Wave one of the ICD-10 implementation is around the corner with 5010 compliance required in January 2012, when all HIPAA covered entities will be required to submit any electronic transaction, (including claims, eligibility and referral authorizations), from its current Version 4010/4010A standard to Version 5010.

As with any major system conversion, at risk is disruption to cash flow, resulting in an impact to the bottom line. The October 1, 2013, deadline for ICD-10 compliance looms ahead; careful planning to include a thorough review of these risks is imperative. As part of a holistic risk mitigation strategy, providers must understand and be able to forecast possible changes to cash flow and engage in advanced planning to protect revenue losses before, during, and post ICD-10 conversion. Organizations who adopt this proactive approach will have a unique opportunity to improve their core business operations, create value, enhance their revenue stream, and optimize costs across the organization. It is predicted that while reimbursements will initially decline with ICD-10 conversion, this opportunity will ultimately better position hospitals in accurately reflecting actual conditions and treatment so that appropriate reimbursement is retained as well as enhancing accuracy of data through the management of a provider’s coding, billing, receivables, as well as payer and external contractor agreements.

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