Revenue Cycle Management : How ICD-10 Coding Impacts RCM for Home Health and Hospice Agencies

The adoption of ICD-10 coding in 2015 has led to an expansive improvement in data quality by improving granularity to foster enhanced specificity in labeling and charting health conditions that lead to morbidity. While the more precise level of detail has improved tracking of conditions, it has also enhanced home health agencies’ ability to collect on claims through insurance providers. ICD-9 set out 3,824 codes for procedures with 14,025 potential diagnoses, while ICD-10 sets forth 71,924 codes for procedures and 69,823 diagnoses. The vast expansion has enabled home health agencies to more accurately and effectively receive reimbursement for care provided through the agency. Following, we will explore some ways that RCM has been impacted by the roll-out of ICD-10 coding. 

Going Beyond Accuracy with Coding 

Avoiding the lengthy and tedious process of rebilling and reprocessing a claim is a tremendous help in fostering efficiency within the RCM process. The cleaner and more timely the billing is at the outset, the less likely a home health agency will be to experience unnecessary delays in payment or claims denials. This new system of ICD-10 coding was built with the express purpose of standardizing and streamlining the coding process for identifying morbidity causes and this helps encoders appropriately diagnose and coded procedures to receive adequate reimbursement.

Accuracy and Efficiency in RCM Helps Improve Claim Approvals and Payouts 

Building out an effective Revenue Cycle Management process will help improve the ability of your home health agency to bill effectively and ultimately receive timely payouts for claims. ICD-10 is a benefit to home health agencies, as it allows more fluid and seamless coding. Installing something as simple as a scrubber can help inspect bills before they are submitted and prevent avoidable errors from delaying claims payments. Preventing unnecessary delays, such as errors in the type of procedures performed and served rendered, will alleviate some of the strain on encoders and help the agency’s billing operations run more smoothly. 

ICD-10 can Help with Rejected Claims 

When your home health agency invests in efficient and up-to-date software, you can limit downtime related to resource allocation which leads to costly delays in payouts. Outfitting your agency with the correct resources will help streamline your billing so that you can improve efficiency and productivity. Identifying potential errors or omissions during a retrospective audit can also improve your agency’s ability to mitigate rejected claims and ensure payment is received in as timely a manner as possible.