Advanced Revenue Cycle Analytics: An Overview
The paper superbill is one of the most productive and widely adopted tools in medical practices in the past 30 years…and it will become extinct on October 1, 2015.
Despite widespread EHR adoption, the paper superbill is being used by more than 54% of physician practices today. It is an incredibly flexible and powerful tool that provides two key functions.
First, it allows the clinician to quickly capture procedure and diagnosis information. The paper superbill can be designed to match the individual needs of the practice, sometimes even at the provider specific level. After years of use, many providers can complete the superbill in less than 10 seconds. The reason this tool is so fast for the provider is that they have developed “muscle memory” to know where the most commonly used codes are on the superbill. In the fee-for-service model the providers’ time is extremely valuable and cannot be compromised.
Simultaneously, claims must be submitted to insurance carriers (public and private) for reimbursement. The paper superbill also provides all of the necessary information to the billing department to submit claims in a timely manner.
The balance of provider productivity and revenue cycle efficiency is the critical blend that makes the paper superbill such a valuable tool for physician practices today.
Unfortunately, the paper superbill will no longer work efficiently after October 1, 2015. To make matters worse, many practices who use these paper superbills today do not realize this process is doomed for extinction.
ICD-10 will introduce complexities that make the paper superbill impossible to use for the provider and billing department.
ICD-10 is a mandatory change for all practices and payers. This is different than any change healthcare has undergone in a generation. ICD-10 is not an incentive program (like e-prescribing, PQRS or Meaningful Use) and applies not only to government payers but all insurance plans. If a practice does not successfully transition to ICD-10 all of their non-patient pay revenue will stop October 1.
Most paper superbills communicate both procedure and diagnosis information to the billing team. Procedures will not change in ICD-10 for the physician practice, but diagnosis codes will. The average paper superbill has 200-300 ICD-9 codes listed which covers 95% of patient encounters. The ICD-10 code set is more detailed than ICD-9. Converting these 200-300 ICD-9 codes into ICD-10 codes, most practices will use 1,200 – 8,000 ICD-10 codes depending on the specialty. This increase in the number of codes used to cover the majority of patient encounters will be impossible to fit on single page superbill.
ICD-10 is not an optional program, it is a mandate for practices. The increase in the number of codes demands a change in the status quo of how providers communicate billing information to the billing team. The paper superbill will no longer work.
Failure to change away from the paper superbill will cause significant productivity declines for providers and will decrease practice cash flow.
More detailed information is required for ICD-10 claims. Practice leaders must come up with a new method to capture the encounter information from providers and send that information to the billing team in order to maintain current cash flow levels. The most difficult part of this process will be to provide the additional detail without slowing down providers or hiring additional staff.
The most pertinent questions are who is going to provide the more detailed information and when. Most providers would prefer to operate at the top of their license by taking care of patients rather than spending time with administrative tasks like coding. However, if the provider gives no additional data billing employees will be unable to assign a more specific ICD-10 code.
Without any workflow changes, providers are projected to spend between 45-90 minutes per day answering follow up questions asking for additional coding detail. This is unacceptable for busy physician practices, because providers cannot spend this time away from patients or away from their families. Both of these are bad outcomes.
An alternative would be to use unspecified ICD-10 codes, however these unspecified codes will cause negative unintended consequences. Payers have advocated for the transition to ICD-10 because they want the more granular data available in ICD-10. Claims are likely to be denied or underpaid if they contain unspecified ICD-10 codes. This option simply shifts the back and forth later in the process and delays reimbursement to the practice.
Paper based options for using a multi-page superbill, a super-sized superbill or a microscopic font are impractical for both the provider and the billing team. Expecting the billing team to code from physician documentation or from written diagnosis descriptions will cause countless hours of lost productivity for the physician and the billing team asking and answering questions regarding more specific coding information.
There is a solution that protects both provider productivity and the revenue cycle process.
AccelaCAPTURE is an electronic superbill designed to look exactly like the paper superbill. This reduces the amount of change and shortens the learning curve for the provider. AccelaCAPTURE allows the user to click or tap to select procedure and diagnosis codes on a computer or table rather than circling the codes on a piece of paper.
During ICD-9 this process is nearly identical to the paper based process. On October 1st, selecting procedure codes is identical to the day before. Selecting diagnosis codes in ICD-10 is very easy. The superbill still looks exactly the same, but when clicking on a diagnosis code the provider is presented with the new code choices in ICD-10. The new ICD-10 choices are organized to maximize the providers productivity and ensure that an accurate, detailed ICD-10 code is selected.
If providers are going to have to provide additional detail to make sure claims are paid after October 1st, we want to do that as efficiently as possible for the provider and at the right time from a workflow perspective.
AccelaCAPTURE minimizes the impact of ICD-10 for the provider. The provider can still use a superbill that is familiar to them and that is easy to complete. The provider can still complete the electronic superbill at the right time in their workflow. AccelaCAPTURE only requires 1 additional click to select the appropriate ICD-10 code.
This process makes it easy for providers to provide the right code to the billing team the first time. Once the billing team has all of the necessary information, they can make sure that claims go out correctly and on time. This prevents costly back and forth communication for the providers, and ensures that the practice can continue to collect reimbursement in a timely manner.
What do I do next?
To sign up to see your own customized electronic superbill and prepare your practice for ICD-10 there are three easy steps.
- Register your practice and upload a copy of your paper superbill by emailing email@example.com
- White Plume will create a site just for you where you can review your electronic superbill
- Once you are satisfied with your electronic superbill, enter your payment information, contact Genius Solutions for the interface and you will be ready to go.