Regulatory Compliance

‘Final’ ICD-10 date to heat things up

Revenue cycle management companies are poised to gain from the ‘final’ ICD10 date says John Andrews after reviewing the most recent Black Book report and interviewing Tom Giannulli, MD.

If survey data from Brown-Wilson’s Black Book Rankings is any indication, professional RCM (revenue cycle management) companies stand to gain a lot of business from physicians for ICD-10 coding.

The Black Book Rankings surveyed 21,079 qualified users between November 2013 and April 2014. The survey asked participants about their medical practice operational priorities over the next few years, and nearly 90 percent of solo and small practice physicians with in-house billers and collectors said they expect to outsource most or all their billing functions over the next 24 months.

Giannulli sees this as a key trend.

“I believe we will see this,” he said.” The majority of clinics favor outsourced billing for their practices because of the complexities with the new codes and time -consuming work involved with it. If you use an RCM contractor you can save money and assign those dollars to care coordination.”

Among the advantages of using a professional RCM company, he says, is that if there is a question as to the correct code, coders can enter ICD-10 descriptions associated with the diagnosis and send to the physician for clarification. The physician receives a URL with the intermediate search state, and once clicked, will provide an immediately scoped set of keywords for selection, quickly resulting in a final code.

One thing is sure, the factors driving practices to outsource are piling up.  Practices face what the AAFP called “the perfect storm” of regulatory compliance this year with the Affordable Care Act, Meaningful Use Stage 2, PQRS, Value-based payment modifiers and of course – ICD10.  It’s just too much.   In Chicago I recently addressed an audience of over 100 of the largest ambulatory organizations in the country and asked how many had heard of VBPM or value-based payment modifiers.  Out of over 250 attendees only two raised their hands.

This is the state of things.  Many of these groups should have been participating in VBPM in 2013.  Groups of 10 providers or more need to participate this year or face penalties.  With all that is going on VBPM has simply slipped under the radar.  If these more sophisticated groups are finding it hard to keep track of all that is required, what are the chances that the smaller groups that are far more resource-constrained are going be able to?

I agree with John Andrews and Dr. Giannulli.  Just keeping track of regulation and compliance issues (let alone implementing them) is a full-time job now and for better or for worse many healthcare organizations will have to rely on outsourcing or co-sourcing to keep up.  Interesting times indeed…

How is your organization tracking and keeping up with these issues?  I’d love to hear about it.


See John Andrews full article below: