ICD-10 is a Major Reimbursement Risk For Doctors


RevCycleIntelligence.com interviewed Michael Clark, Chief Operating Officer at Evariant, to understand his opinion regarding physician focus for revenue cycle and cash flow, what the CMS means by successful end-to-end testing, suggested areas of concentration for CFOs, and physician engagement implications. The following is a summary of some of Clark’s main points:

  • ICD- 10 Challenges: The biggest challenge with ICD-10 is the clinical documentation and its impact on productivity and reimbursement. There is no near- future perceived benefit for the physician if he or she transitions to ICD 10, which is why physicians advocates keep trying to delay its implementation.
  • ICD- 10’s Impact on Revenue Cycles: The burden completely falls on the physician, who the health system cannot control. There are many issues that could occur to delay the revenue cycle. For example, if the physician knows the specific documentation needed, but it unable to document it in the EHR. Additionally, the codes will need require more documentation, which will force the physicians to spend more time recording that they had previously.
  • CFOs Approach to ICD-10 Based Revenue Cycle Issues: Traditionally, CFOs are not focused on the revenue cycle (i.e. how to get the patient into the hospital with the right service that optimizes revenue), but rather on operational matters, such as cash management. However, now that the healthcare industry is transitioning to value- based pricing, CFOs need to concentrate on consumerism strategically.
  • Evolution of Physician Engagement: Physicians need to be engaged in their specific specialty or service and create strategies to coordinate. Patients need to know who their physicians are or else patient volume will decrease.

Written by Caroline Smith

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Caroline Smith is currently a senior at the University of Notre Dame and is a contributor to Medical Groups. She is majoring in Science-Business and Spanish. After graduation, Caroline plans on entering the field of healthcare consulting. She is most interested in the evolving policy changes in the healthcare industry and enjoys learning about new technologies that are being developed.