For providers, leveraging population health data key to ICD-10 survival

The nightmare scenario envisioned by some healthcare providers and insurers following the implementation of ICD-10 on October 1 has yet to materialize. On that much, panelists at the recent Revenue Cycle Solutions Summit in Atlanta agreed.

But panelists said that as the new year unfolds, shifts in industry practices prompted by ICD-10 could imperil some providers, according to an article in Healthcare Finance News by Susan Morse.

"The bottom line is the people most at risk for losing are providers," said Joe Nichols, principal of Health Care Consulting. "Payers are like Realtors, they still get their commission.” Mike Simms, vice president of Revenue Cycle for Cone Health, also said hospitals have the most to lose, and said this would be an eventuality when it comes time for payer-provider contract negotiations.

"Hospitals are going to see decreases from the managed care players," Simms said.

On top of the revenue strain caused by claims delays and denials – which CMS has warned could afflict providers for as long as two years after ICD-10 – less favorable contracts with payers will only add to revenue cycle instability as a greater share of the payment burden falls to patients, many of whom struggle to cover medical costs out of pocket.

One effective weapon against revenue cycle disruptions in the wake of ICD-10 is data analytics, Nichols said.

"If we have better data we can truly improve the cost effectiveness of data,” he said. “The folks that have the most control over the data, the most accurate data, will win."

That means more than collecting accurate data; it means mining that data, both to detect and predict population health trends and to uncover documentation or process flaws that are creating billing and reimbursement problems.

Analyzing the right data also allows providers to gain valuable clarity into their revenue cycle and related processes, enabling them to identify high-volume and high-value treatments and procedures. These are the ones which deserve the most attention in terms of the ICD-10 codes that clinicians and support staff must learn – particularly if the translation of these high-value and/or high-volume treatments to the new code set is particularly complex. 

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