Jvion Releases Guidance on Protecting Professional Fee Revenues from ICD-10

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Work to address ICD-10’s financial impact has focused primarily on inpatient settings leaving gaps in risk related to professional fee reimbursements. Jvion—the leader in ICD-10 analytics—recently released guidance on the importance of understanding and addressing ICD-10’s potential repercussions for this significant and critical portion of provider revenues.

One CFO was able to determine that she needed 200 AR days worth of cash on hand to support her outpatient/ambulatory operations

With the ICD-10 compliance deadline looming, many providers are kicking their programs into high gear. And those segments that have lagged in their timelines, such as physician’s practices, are working to quickly catch up to recommended milestones. While most of the focus on revenue impacts has remained on inpatient facilities, more and more providers are realizing the great value that a professional fee revenue impact analysis can have in mitigating risks and projecting needed cash reserves. These reserves are critical to surviving the anticipated blackout period that will follow the initial conversion to the ICD-10 code set. This 90-day timeframe is expected to decrease incoming revenues while increasing operational costs because of:

  •     Uncertainty about documentation quality and medical necessity
  •     The need to rely on experts and outside consultants
  •     Delayed payments and decreased cash on hand
  •     A lack of data and feedback from external sources
  •     Increased stress and workload for provider resources

Jvion—the leader in ICD-10 analytics—recently released guidance on the importance of understanding ICD-10 reimbursement risks for professional fee claims. This guidance comes on the heels of the firm’s leadership at the HIMSS14 ICD-10 Symposium where many of the attendees sought information on revenue and operational impacts beyond the inpatient setting.

“Our goal is to help providers close the gap on the indirect financial impacts resulting from the move to ICD-10,” explained Todd Schlesinger, Vice President of Business Development for Jvion. The eight points released by the firm suggest that providers examine their professional fee claims impacts to:

  •     Proactively address medical necessity-based denials arising from unspecified and lesser specific coding in ICD-10
  •     Reduce 3rd party physician audits
  •     Avoid increased payor scrutiny
  •     Enable a more focused and structured program by prioritizing top risk areas
  •     Pinpoint ICD-10 financial risks based on billed and paid amounts due to unspecified/codes with complex maps in ICD-9
  •     Drive physician engagement
  •     Estimate departmental backfill and productivity needs
  •     Analyze specific denial codes based on medical necessity and update existing denial management practices accordingly

“The take-home message is this, ‘it isn’t too late to protect your professional fee revenues from ICD-10’,” said Todd. “Many providers are trying to determine just how much cash they will need to float the initial period following the conversion. Having a detailed understanding of revenue risk can help target this number. Just recently, one CFO was able to determine that she needed 200 AR days worth of cash on hand to support her outpatient/ambulatory operations. For many facilities, having that kind of insight can mean the difference between keeping the lights on and turning them off forever.”

About Jvion
Jvion is a healthcare technology company that develops software designed to predict and prevent patient-level disease and financial losses leading to increased waste. The company offers a suite of big-data enabled solutions that combine clinical intelligence with deep machine learning to help providers protect their revenues while improving patient health outcomes. Their objective is simple—stop the waste of resources and lives by predicting and stopping losses before they ever happen. Jvion is distinguished in the industry for their leadership in the area of healthcare predictive analytics including their most recent recognition from AHIMA as the 2014 Innovator of the Year.

About ICD10
ICD (International Classification of Diseases) is the code set used to report medical diagnosis and procedures. It is used by healthcare providers to communicate what was done to you and why to your insurance. And it is how an insurance company determines the reimbursement amount to send back to your healthcare provider. We are currently on version 9 (ICD-9) and are moving to 10 (ICD-10). Here is the U.S., we are late to the ICD-10 game. In fact every major developed nation already uses the code set. ICD-9 is more than 30 years old, includes outdated terms, and is inconsistent with current medical practices. Moreover, it cannot accommodate newly developed diagnoses and procedures, innovations in technology and treatment, performance-based payment systems, and more accurate billing requirements. Everyone covered by HIPAA must use ICD-10 starting October 1, 2014. This includes health care providers and insurers who do not deal with Medicare claims. Only workers comp is excluded from the transition. In total, ICD-10 adds up to an $8B challenge for the industry. Every system, coder, physician, and insurance company that deals with ICD-9 will have to convert. And if this conversion isn't done correctly, providers stand to lose millions to reduced reimbursements and extended A/R cycle times.

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Allison Alavi
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