You are in the process of finalizing your first month-end after the October conversion to ICD-10. Of course you had a few glitches, that was to be expected. And of course you have done a good job of clearing up those glitches and ensuring the smooth operation of daily processing of charges and payments/remits.
So the big question is, how does month-end look? You should do your regular due diligence for month-end like you always do; comparison of payments to charges, what did you do last month, the last six months, a year ago today, etc. What do denials look like? Any new denial messages like invalid ICD-10 code? Most of your ICD-10 denials should have been resolved through the month as you received them and in some cases, you were asked to re-submit charge as the code should have been accepted. This will of course effect payments for the month. How many of those you received will make a big or small impact depending upon volume.
The “high five, we did it celebration” can begin when you have confirmed you got paid the right amount from your carriers. If you can go to admin with that news……CONGRATS! If you did not and are finding more problems than solutions, less cash than expected and a multitude of issues, you need to call someone and get a third party opinion of what’s going on. So why do you need to do that?
Presumably you did the testing, the confirming of testing and all the training needed to complete the conversion. If you believe you did that and are still having problems, you may not be able to see the details of the issues. A third party can and will see those details and get you back where you belong quickly and efficiently.
If you experienced no issues with conversion but are having cash flow problems, there may be multiple reasons:
- Slower keying of charges may mean the normal volume of charges did not go into the system, hence payments will be down. This should pick up over time, but you may also need to realize a new normal for some months.
- Slower coding by coders. This may also mean fewer charges and fewer payments. However, coders should be productive. They were expected to be productive using ICD 9 codes and that expectation remains. They should quickly get up to speed and know that is your expectation.
- You used a crossover code (ICD 9 to ICD 10 combination) and the payment is less than you expected. For this problem, conversations with carrier should be undertaken. Especially on high volume codes.
Have a good month-end? Excellent! Throw a party for the business office. Having struggles? Give Medical Management Services a call. We have the expertise and solutions to help get you back on track.