Just when you thought you had a firm grasp on the revenue cycle operations at your provider organization, 2015 comes along and changes everything. ICD-10, Affordable Care Act (ACA) plans and, perhaps, a merger or acquisition at your organization presented major challenges to managing revenue cycle performance.
In greater detail, the following are just a few of the major trends that impacted provider organizations’ revenue cycles in 2015 and recommendations about what providers should do in the New Year.
1. ICD-10. The industry transition from the ICD-9 to ICD-10 coding set was a major impact to revenue cycle, although by most accounts so far, the process for provider and payer organizations has been relatively smooth. A big wrinkle, however, is that the Centers for Medicare and Medicaid Services is giving provider organizations a one-year grace period from claims rejections based on ICD-10 specificity. In 2016, provider organizations need to conduct an audit of their ICD-10 coding performance to ensure that any lack of specificity isn’t going to come back to haunt them later and that physician documentation can accurately support all of the billed codes.
2. ACA plans. Also last year, 11.7 million Americans enrolled in an ACA health plan that was purchased through a state or federal health insurance marketplace. On the revenue cycle side, as in 2014, providers needed to educate these newly insured patients about their financial responsibility under these plans. However, other providers struggled to verify eligibility and obtain reimbursement because the patient had not yet paid the plan’s premium. In 2016, providers may have to devote more resources to assist patients in understanding their ACA plans and perform an IT assessment of financial systems to ensure they can effectively manage these new plans.
3. M&A. Healthcare merger and acquisition activity increased 16.3 percent in 2014 compared to 2013, and was expected to continue at that pace in 2015. If your organization underwent such an ownership change, then revenue cycle operations will likely need to be integrated and standardized to ensure that reimbursements aren’t lost between the merging institutions. In a future blog post, we’ll explore how more provider organizations are pursuing revenue cycle integration to maximize efficiency and reimbursement in a value-based payment world.