Just when you thought medical billing couldn't become a more complex process, it is set to do just that in 2015. Medical facilities could find their incomes affected unless they have a strategy ready for many of the changes expected to take place this year. This may be true even for practices that are experiencing above average financial outcomes.
How Revenue Cylce Management Will Be Impacted in 2015
Increased regulatory obligations, higher drug prices, and an aging population that requires more services are complicated by three other important changes:
• The ICD-10 transition
• More HIPAA audits
• Increasing number of high-deductible health plans
Here is what you should know about these changes and their potential impact on medical billing, plus information on how practices can prepare.
1. The ICD-10 Transition
Several countries have already changed from the ICD-9 code set to ICD-10. ICD-10 is up-to-date with the current technology and conditions medical providers see and provides for much more detailed information to enrich healthcare reporting. For medical coding professionals, the ICD-10 transition is like learning a new language, because ICD-10 has tens of thousands more codes than ICD-9 did, and the coding rules are somewhat different. Coders will be expected to increase their familiarity with physiology and anatomy of the human body to keep up with the new ICD-10 terminology. With the transition deadline being October 1, there isn't much time left to prepare.
A successful ICD-10 transition will require training for all medical billing personnel and other staff affected by the change. Some facilities will accommodate the change by outsourcing revenue cycle management operations, while others will be handling the switchover in-house. The Centers for Medicare and Medicaid Services (CMS) offers "Road to 10" online resources for smaller practices, with tools to help them plot out their ICD-10 strategy.
2. More HIPAA Audits
The Office of Civil Rights is stepping up its HIPAA audit program in 2015. This round of audits will focus on day-to-day application of HIPAA policies and procedures throughout health provider organizations. Your entire staff and your vendors will be expected to know relevant policies and procedures and how to use them. During the previous round of HIPAA audits in 2013, only 11% of audited organizations were free of problems.
Being ready will require most facilities to review procedures and retrain personnel. Facilities will also need to review the services provided by any business associates to check for possible gaps in HIPAA compliance due to these relationships. An internal self-audit focusing on security encryption, EHR procedures, data transmission, and media controls can help identify potential problems with HIPAA compliance.
3. Increasing Number of Patient with High-Deductible Health Plans
With the Patient Protection and Affordable Care Act, more Americans now have health insurance but also extremely high deductibles. Florida, Texas, and Illinois are three states with a high-proportion of people with high-deductible (in some cases, $8000-plus) health insurance. With high-deductible plans and many patients adopting healthcare plans for the first time in years, medical billing professionals and medical practices nationwide will have to focus more on patients as sources of payment, rather than focusing on insurers.
Front office training will be essential for properly directing medical billing efforts. Confirming patient coverage, obtaining necessary authorizations, and discussing payment plans with patients are three steps providers can take to prevent miscommunications and collections problems. Simultaneously, your insurance claims professionals will have to maintain vigilance and high standards to keep denied claim rates under control.
How to Prepare and Manage Revenue Impacting Changes
There is simply no substitute for good planning, regardless of how your facility plans to address HIPAA audits, ICD-10, and high-deductible insurance policies. Fortunately, you have many training options, including online training, to help ensure medical billing personnel are up to speed. Many facilities plan to outsource some or all revenue cycle activities as a cost-containment and risk reduction approach.
To help your practice succeed with patient payments, research patient payment tools or partner with a revenue cycle management team that can assist you in implementing such technology alongside patient pay best practices. Giving your patients the ability to make payments online and set up payment plans will dramatically help your medical practice's cash flow.
With technology-related demands like the ICD-10 transition and HIPAA compliance, thorough testing of systems before they go live is necessary. Meanwhile, claims specialists must not only be ready to use ICD-10 in the submissions process, they must also monitor claim rejections and be prepared to respond swiftly if rejection rates increase.
Whether or not a practice outsources revenue cycle activities, EHRs will be a key to long term success. The change from paper to EHRs is a big one, but long term benefits will include a faster revenue cycle, fewer errors, and more accurate patient data to allow for higher quality care. If your practice is not yet using an EHR, research possible solutions today.