2 min read

Maintain a solid financial footing through the quagmire of ICD-10 implementation

By Prime Care Tech Marketing on Wed, Sep 16, 2015 @ 03:00 PM

ICD-10: Are you ready?

I have been around the proverbial block of Long Term Care many times over the last 30-plus years. Occasionally. I have seen signs of pending change—sometimes immediate and sometimes off in the distant, protracted future. Rarely in the last 10 years has any change been more dramatic and more protracted than the transition from ICD-9 to ICD-10. And now it’s here, ready or not. 

Business_Ready_300x286The New York Times (9/14, A1, Pear, Subscription Publication, 11.82M) reports that the change “is causing waves of anxiety among health care providers, who fear that claims will be denied and payments delayed if they do not use the new codes, or do not use them properly.” While many providers, I anticipate, have prepared themselves for the change, some may be less certain. This may result in delayed or denied claims with disruptions in cash flow.

Is your team ready for ICD-10? There are so many bases to cover, so many details to acknowledge, so many tasks to take on, and so many transitions to tackle. You’ve planned. You’ve trained. You’ve directed. You’ve encouraged. You’ve engaged. But sometimes, it’s the small and basic tasks that can trip you up or elude you, as you make your way around your own potential LTC ICD-10-studded block.

Get a solid footing – check out the basics – one more time

For example, MLN Matters® Number: SE1408 points out that “ICD-10 diagnosis codes have different rules regarding specificity and providers/suppliers are required to submit the most specific diagnosis codes based upon the information that is available at the time.” Here are a few tips from our “ICD-10 Readiness Briefing” to help you round the next billing block on solid ground:
To assure a smooth transition, have a clear picture of your entire claims submission process. Be sure each stakeholder in the process is ready for the transition.

1. Three mission critical steps to confirm ICD-10 readiness. Confirm that:

  • Clinicians and biller(s) are trained.
  • Your EMR partner has a crosswalk from ICD-9 to ICD-10 codes and has tested its systems.
  • Your clearinghouse and key payers have all the new codes in place and have completed their testing successfully.
2. Your claims Clearinghouse should help you to:
  • Identify problems that lead to claims being rejected
  • Provide basic guidance about how to fix a rejected claim
  • Edit the claims to ensure appropriate code sources are used, based on date of service and/or discharge date.

3. Your EMR vendor should supply crosswalks to assist in selecting appropriate groups of ICD-10 codes to use.

Are you ready? What steps has your organization taken to ensure that the ICD-9 to ICD-10 transition is as smooth as possible?

Our free two-page “ICD-10 Readiness Briefing” contains more useful information to make sure you are ready.

There's still time.


Topics: long term care EMR
3 min read

Improve claims turnaround and business processes – a case study

By Proclaim Partners on Wed, Aug 13, 2014 @ 09:00 AM

istock_000017882928smallCMS Says Skilled Nursing Will Face Negative Margins By 2040,” so read the headline in last Wednesday’s AHCA/NCAL Gazette. In fact, it was the top story. Yep. It grabbed my attention really quick. Now granted, I may likely not be around by 2040, but judging by my parent’s longevity, I could. I’ve been affiliated with LTC since 1978 and it’s in my blood. I care. And, yes, to be frank, the article somewhat spooked me when I read the following, “By 2040, two-thirds of skilled nursing facilities will be operating in the red, signaling more consolidations, partnerships and accountable care organizations (ACOs) on the horizon, according to a recent memo issued by the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary.”

Here are a couple of reasons why I am spooked. First of all, I have seen projections of the future, especially those going further out than 10 years, either flat out ignored or at least not effectively addressed. Perhaps, we hope the projections are wrong or that someone someday may do something about the issue at hand. It never ceases to amaze me that the future eventually becomes the present. Have you noticed that too? Rephrased, have you acknowledged that truism as well?

Secondly, I am spooked because I’ve noticed that when it comes to health care policy, government at the federal and state levels feels that it will have the answers. Their track record has not convinced me that government is or should be the problem solver. So what can LTC providers do today to meet the challenges the years leading up to 2040 will pose? Well, they can start today to embrace and implement available practices and technologies to build a solid financial footing by quickly collecting claims processed.

Ensign Services did just that. A recently-published ProClaim Partners case study revealed that Ensign Services faced several challenges:

  • Ensign Services needed to replace a legacy clinical and financial software application which included a basic claims submission automation feature.
  • The new software Ensign Services implemented met its EMR requirements, but lacked automated claims submission to Medicare. This also became the catalyst for consideration and conversation about clearinghouse services to all payers.
  • To compensate, Ensign Services selected a widely-used clearinghouse. The new clearinghouse was unwilling and unable to support Long Term Care-specific claims submission and management requirements.

To overcome these challenges, company executives arrived at the following conclusions:

  • Ensign Services needed a responsive and easy-to-use enterprise-class claims clearinghouse designed specifically for Long Term Care to help its clients meet their respective cash flow objectives, save money, reduce unnecessary claims processing and collections tasks, increase user satisfaction, and streamline business workflows.
  • Because of its relationship with Prime Care Technologies, Inc. for IT hosting services, Ensign Services investigated PCT’s affiliate, ProClaim Partners, LLC, and discovered that it could assist them in managing client claims.

The results? Since fully implementing the ProClaim Partners solution, Ensign Services has been able to:

  • Decrease claims turn-around time
  • Significantly improve claims management-related business processes
  • Reduce frustrations related to new client on-boarding
  • Experience quicker special requests and support issues response times

Is this THE answer to the spooky negative margins providers may experience by 2040? Not entirely. But as margins get tighter, a quicker turnaround of claims processed will be critical. The fact is it is critical today. Those providers who take steps today to improve cash flow through claims automation will not only have the advantage in the future, but also right now. At least with a better cash flow position, providers can focus on the factors influencing the bottom line.

At least those are my “thunks”.

Have you fully automated the claims management process? If so, what advantages are you seeing today?

Topics: Improved Business Processes claims management clearinghouse IT hosting services claims turnaround claims turn-around clinical and financial software claims processing EMR claims management process


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