Home' The Source : First Quarter 2016 Contents SOURCEBOOK TECH TRENDS
also points out that the coder shortage will
“Will the pricing of contract coding, the
bonuses and the whole compensation game
settle down, or will there be a new norm?
The jury’s still out on that,” she says.
Understanding Revenue Impacts
Beyond staffing costs, healthcare leaders
have been concerned about the potential
revenue impact of ICD-10. Many experts
predicted significant spikes in claim denials,
a fear that hasn’t materialized so far.
“Cash is coming in the door and claims are
being paid,” Nichols says. “We’re definitely
seeing some DRG [diagnosis-related group]
shifts—some we predicted, some we didn’t.”
She adds that it’s too soon to tell what the
short-term, intermediate and long-term
ramifications will be.
Chad Wasserman, Parallon’s Revenue
Cycle Services’ chief information officer,
says the next few months are important
for watching how payers respond to the
change. According to Wasserman, leverag-
ing advanced data science can help hospitals
stay ahead of major revenue shifts.
“It will be interesting to track how payers
process claims and map codes, and whether
that’s consistent across geographies and
different payers,” he says. Proactive manage-
ment of key performance indicators (KPIs)
such as claim denials and case mix index
(CMI) can provide valuable insights into
coding quality and DRG shifts.
“We’re still in the first stages, but there’s
good intelligence to be gained,” Wasserman
says. “We may be able to see earlier signals
of what’s occurring—good or bad—and take
action based on that intelligence.”
That could mean renegotiating contracts
with payers, adjusting expected reimburse-
ment models, adding more staff or even
changing business systems.
“Predictive analytics let you know when
you’re walking into a problem so you can
head it off,” Wasserman says.
And while insurers and clearinghouses
alike have reported minimal difficulties
thus far, Parallon experts aren’t willing to
declare victory until trends in payer behav-
ior become clearer.
The Provider Perspective
Early reports revealed some complaints
from providers, including a few technol-
ogy glitches and trouble getting accurate
information on coding requirements. Aside
from those initial bumps, however, prob-
lems have been relatively minor and few.
Aron Wahrman, M.D., a plastic surgeon at
Temple University School of Medicine and a
HealthTrust Physician Advisor, believes the
electronic medical record (EMR) has largely
shielded providers during the transition.
“This is one of EMR’s benefits,” he says. “A
lot of the conversion has been built into the
system. When I drop down the descriptor,
the proper ICD-10 code comes up.”
The updated codes now allow clinicians
to capture important specifics like whether
it’s an initial or follow-up visit, or wheth-
er a patient’s right or left hand is injured.
This increased precision has the potential to
deliver more robust data to track treatment
and outcomes from health records.
“The transition reflects the fact that so
much of healthcare is going to be driven by
data,” Wahrman says. “We’re trying to adopt
a language that’s much more accurate in
painting a clinical portrait of what’s going
on with a patient.”
He says the change was a long time com-
ing, pointing out that ICD-10 has been
available since the early 1990s and widely
used in other countries since 1994. Overall,
the increased refinement and code specific-
ity was necessary as EMRs and meaningful
use became more important.
“It’s really about making sure everybody’s
on the same page, using the same language
to make sure the flow of information—as
well as the revenue to take care of patients—
Continued from page 21
As things continue to settle during the
ICD-10 transition, hospitals must continue
to watch coder productivity and payments
in order to stay ahead of any potential
revenue impacts. To do that:
• Manage your coding staff. It’s essential
to closely track turnover rates and get pro-
active about hiring before problems occur.
It’s also crucial to remember that accuracy
is just as important as productivity.
• Support your clinicians. Identify super-
users who can help colleagues on the job.
Medical scribes can also help with real-time
transcription of medical records.
• Monitor your KPIs. Revenue cycle
teams should keep a close eye on claim
denials or rejections, as well as the CMI and
any DRG shifts. Predictive analytics and
business intelligence can be used to drive
actionable insights and keep hospitals on
the right track.
Tracking ICD-10 Impacts
22 The Source | First Quarter 2016
1/21/16 2:28 PM
1/21/16 2:28 PM
Links Archive Fourth Quarter 2015 Third Quarter 2016 Navigation Previous Page Next Page