Medical Billing and Coding Healthcare Blog

With the ICD-10 go-live date of Oct. 1, 2015, less than 100 days away, it is imperative for organizations to continue their preparation efforts for the significant transition from ICD-9 to this new code set.

As part of its "Road to 10" online resources for providers, the Centers for Medicare & Medicaid Services (CMS) has released a series of webcasts designed to help with ICD-10 clinical documentation specific to various medical specialties.

The first webcast, released last June, focused on orthopedics. An AHIMA-certified coder presented on the webcast, which discussed unique ICD-10 clinical documentation needs and hot topics for orthopedics, including the following:

  • Physician perspective/clinical impact of ICD-10
  • Documentation requirements for certain conditions
  • Documentation changes and new concepts
  • Use of "unspecified" codes in ICD-10

If your organization performs orthopedic billing and coding, this program may assist in the transition process. If you watched the webcast when it was initially released, it may be worth revisiting since more than a year has passed.

To view the orthopedics webcast, as well as the other specialty-specific webcasts on ICD-10 released by CMS, click here.

PGM Billing launched ICD-9 to ICD-10 crosswalks for some of the most commonly used ICD-9 codes to ICD-10 for over a dozen specialities, including orthopedics lower and upper body codes.

PGM Billing provides a number of services to physician practices, ambulatory surgery centers, labs and other providers. One of these services is revenue cycle management, or RCM.

When organizations ask what PGM can do for them and we mention our extensive experience with providing revenue cycle management services, it's not unusual to hear the question, "What is revenue cycle management?"

We thought it would be helpful to address that question in an objective manner by sourcing the words and knowledge of other RCM experts.

HBMA — the Healthcare Billing & Management Association — says the following: "Revenue cycle management (RCM) is the process that manages claims processing, payment and revenue generation. It entails using technology to keep track of the claims process at every point of its life, so the healthcare provider or medical billing company doing the medical billing can follow the process and address any issues, allowing for a steady stream of revenue. The process includes keeping track of claims in the system, making sure payments are collected and addressing denied claims. RCM encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims using CPT and ICD-9 codes."

MedPageToday's Rosemarie Nelson writes: "Revenue cycle management (RCM) is the lifeblood of every practice. Effective patient registration, insurance and benefit verification, charge capture, and claims processing are essential to maintaining viability."

Healthcare IT News defines RCM as: "...the process of managing claims, payment and revenue generation. RCM encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims."

The Houston Chronicle states the following: "In a hospital context, the purpose of revenue-cycle management is to optimize the patient financial experience along the entire continuum of care. This means that various patient financial touchpoints — including insurance contracts and the collection of co-pay and deductible expenses — require the patient's active involvement. Hospitals retain a strong incentive to harmonize the patient financial experience to improve patient satisfaction and to reduce the risk of denied charges by insurance companies.

A Healthcare Information and Management Systems Society (HIMSS) report (pdf) says RCM ..." extends beyond patient billing and collections; it incorporates checking eligibility, collecting complete patient demographics, benefits verification, capturing charges, coding, claim submission, collecting and posting payments from patients, denial management, reporting and data analysis. The main objective is maximizing revenue while optimizing patient satisfaction."

If you still have questions about what RCM is or how PGM's revenue cycle management services can improve your organization's financial performance, please contact us today!