Five Ways to Improve Your RCM Process in the First Few Months of ICD-10

ICD-10 is here in full force, and many providers are already feeling the effects. Slowdowns and the anticipation of the first round of claims denials have many providers biting their nails hoping that they can somehow come back up to speed.
While a rocky ICD-10 implementation transition should be expected as your organization irons out the kinks, there are still many strategies you can employ to eliminate pain points, avoid claims denials and speed up your RCM processes in general. Here are a few suggestions that can revamp your RCM efforts and improve reimbursements overall:

1. Invest in Training
The coding procedures of ICD-10 are much more complex and intensive than the legacy ICD-9 system before it. While there were around 13,000 codes in ICD-9, ICD-10 has 68,000. Merely trying to translate ICD-9 to ICD-10 simply will not work because of the incredible new levels of nuance and complexity afforded by the ICD-10 coding system.

Train everyone in RCM on the ICD-10 procedures for claims, appeals and obtaining guidance from the CMS. Every employee should have at least cursory knowledge of the general theory and practice behind ICD-10 coding, and senior staff must have a definitive working knowledge of the coding procedures. With these knowledge leaders in place, your RCM staff can have someone to consult when they get confused about what they need to do next rather than throwing up their arms in frustration.


2. Appoint New Positions
One of the best ways to streamline RCM may seem like it adds more blockage to the workflow, but in the end it will help reduce setbacks that keep claims in billing for too many days or have reimbursement requests denied repeatedly.

Namely: hiring or appointing new staff positions. Having someone audit all claims before they are submitted helps ensure a lower incidence of denial. Having another person or group of people handle every denied claim and enact a dedicated appeals procedure helps prevent taking work power away from filing incoming claims from billing. The team that handles denied claims can also inform training processes down the road so that common mistakes are addressed.


3. Optimize Your Front Office with Automation
Many front offices are structured with redundancies or out-of-date practices that hinder efficiency. For example, many offices have manual processes that bog down claims submissions while causing newly-admitted patient accounts to become piled up behind them.

Developing some sort of automation for multiple stages of the billing cycle has been a popular solution to this problem. In the words of the Becker’s ASC Review: “Automating eligibility verification and patient cost estimation processes are two front-end improvements that can increase and accelerate revenue in two ways. First, it will decrease claims errors, thus ensuring you’ll have fewer denials and rejections. Second, it will enable staff to generate fast, accurate estimates, which will not only improve productivity, but will also increase patient collections by facilitating payment at point of care.”


4. Restructure Your Workflow
Like a tiny, one-story home that has achieved monstrous size with pieced-together additions and outbuildings, adding on new procedures to your existing RCM practices can make them unwieldy and not fit-for-purpose.

Evaluate your current front office and RCM procedure to map out how typical workflow occurs for Medicare patients, private insurance patients and self-pay patients alike. See if you can redraw that structure to be a more streamlined workflow that facilitates modern billing and claims request procedures rather than working at cross-odds with them.


5. Test Continually
You will need to periodically evaluate your RCM systems and procedures to ensure that everything is occurring optimally. The CMS and many payer systems recommended testing before ICD-10, but there is no reason to stop now.

Give your system a periodic “health checkup” that can highlight problem areas that are not so evident during day-to-day operations. Submit sample claims, audit them for correct coding and submission requirements and make recommendations based on problematic trends you identify.


Following these tips may require some up-front investment, but they will help providers avoid crippling claims denials or workflow interruptions in the long run. All a healthcare organization can really do in this situation is put more measures in place that prevent mistakes from happening while learning from the mistakes that still do happen. In the end, we will all get through ICD-10 one day at a time.

There are many strategies you can employ to eliminate pain points, avoid claims denials and speed up your RCM processes during the ICD-10 transition.

Author Bio:
Alex Tate is a digital marketing specialist, content strategist, and a health IT Consultant at CureMD who provides perceptive, engaging and informative content on industry wide topics including EHR, EMR, practice management and compliance.