Chris Nerney
While CMS said it was "pleased to report that claims are processing normally," it's worth keeping in mind that the government agency has taken several temporary steps to smooth the transition to ICD-10 which may be masking problems that could manifest themselves down the road.
Uncertainty over which vendors offer the best revenue cycle management platform for them is motivating a growing number of hospitals and physician groups to outsource revenue cycle processes in lieu of making a large investment in software, according to a new report by BlackBook Research.
An August survey by Navicure/Porter Research shows that an "overwhelming majority of participants" anticipates an immediate increase in their denial rate, with 56% of respondents citing ICD-10's impact on revenue and cash flow as their top concern.
For many healthcare providers, this shift from fee-for-service payments requires a number of strategic and systemic changes that, even if implemented efficiently, could put stress on their revenue cycles.
Blue Cross and Blue Shield of Illinois has developed accountable care organizations with three more provider-partners, bringing the total number of ACOs under the insurer to five, the insurer announced this month.
As part of CMS's ICD-10 transition outreach, the agency will appoint an ombudsman to help handle physician and provider issues as they arise.
On the financial side, revenue leakage can be caused by a number of factors, including late filings, missing authorizations and inconsistent collection follow-up.
Total Medicaid revenues for these MCOs soared 103 percent to $110.6 billion in 2014 from $54.6 billion in 2010, according to a study by Milliman.
Most U.S. healthcare providers are simply unprepared to convert to new payment models, according to a recent survey by KPMG's Healthcare & Life Sciences Practice, which found only 15 percent of the 164 healthcare professionals surveyed said their finance departments can support capitation, bundled payments and quality-based payments.
The change from a fee-for-service healthcare model to a value-based approach might be inevitable, but that doesn't mean it's happening quickly. In fact, the majority of providers remain tied to the old model.