Choosing the Right RCM Partner for Your ICD-10 Conversion

The transition to ICD-10 is the biggest change to face our industry in decades. Essentially everything associated with coding a patient encounter and submitting that encounter for payment is going to have to change.  There is the potential for major disruption in operations, payment streams and productivity for those that don’t adequately prepare. So, how do you survive? For many practices, the best option will be to engage with a revenue cycle partner that has already made the investment in the tools, systems and training and can provide a turnkey solution for your practice. The benefit being you can leverage the resources and capabilities of a trusted, stable partner that has the expertise, technical knowhow and capital required to make the shift. The right partner can help your practice continue to thrive through this transition. But it is important to choose the right partner. Not all RCM providers are ready yet. Here are some questions you should you be asking?

  1. When will your ICD-10 compliant system be ready?According to a recent study by the Workgroup for Electronic Data Interchange, only 1/3 of vendors say they are already ready for the ICD-10 changes. The other 2/3 are not yet capable of ICD-10 processing, and this keeps health organizations from being able to complete testing.Of that 2/3, 60% said they would be ready sometime in 2014. That still leaves 27% of overall vendors that responded to survey that are not ready and would not have been ready by the 2014 deadline. It is important that you try to get a firm answer from your vendor about product release dates so you can plan your own efforts accordingly.
  2. Are there any additional costs involved for upgrades or ongoing maintenance?Some RCM providers are issuing software upgrades, while others are producing an entirely new version of their product.  Ask if you will be charged for the software updates, and how much. A true partner will consider it their job to ensure the system is compliant, and not charge clients any extra fees to complete this work.
  3. What customer support and training will be provided?If your RCM partner is planning software updates this means your staff will need training on new templates, layouts and processes. Additionally, the ICD-10 conversion will bring with it a whole new blitzkrieg of changes to workflow.Look for a provider that will work with your practice to appropriately prepare your staff for the change. Online training programs allow staff to train on changes when and where they choose. Self-assessments indicate where staff excel and where more attention is needed. Not all RCM partners will offer training and some that do might charge for it. Make sure you find out.
  4. What is the basis of your crosswalk or mapping strategy?GEMs will be a useful crosswalk tool, but it won’t be enough.  Only one quarter of the ICD-9 codes will have an exact match in ICD-10.  The reality is that GEMs helps to ease the transition to ICD-10, but it is not the long term solution.  There is no silver bullet and training and education is a huge component of the ICD-10 migration.A savvy provider will supplement GEMs with extended search capabilities. SNOMED-CT can be mapped to ICD-9 and ICD-10. “My lists” and “Frequently Used” lists will need to be enhanced to include the ICD-10 code sets. Natural language parsing allows users to use simple clinical keywords to find the appropriate code. “With,” “Without,” and “And” promote improved specificity. Ask if the system supports non-covered entities that don’t have to make the transition to ICD-9 immediately with automatic codeset selection based on known payor readiness. Make sure that your RCM partner truly understands the challenges of translating ICD-9 into ICD-10 before you get bogged down in an insufficient product.
  5. Will your product support dual coding?Dual coding allows medical coders to use ICD-9 and ICD-10 codes in a chart simultaneously to practice using the new system before it begins to affect revenue and billing cycles.Dual coding can also be useful in creating benchmarks for future productivity. Helping management understand the adjustments that will be needed once ICD-10 comes into full effect. Finally, dual coding also allows for testing with outside organizations, like payers and clearinghouses, to ensure that all systems are a go before they’re actually needed. If you plan to include dual coding in your implementation plan, be sure that your vendor supports it.
  6. What is your external testing strategy?External testing is a critical part of the ICD-10 conversion process, and a key factor in ensuring that revenue will continue to flow after the transition. Find out when and how your RCM partner plans to test their products.  Catching problems before they start affecting your bottom line will save you some headaches come transition time.

Asking the right questions is the best way to ensure that your RCM partner, and therefore your organization, is ready for the ICD-10 conversion. The sooner you find out what needs to be done by your partner, the sooner you will be ready.

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