Developing a Provider Network Strategy that Supports EHR/EMR and ICD-10

The adoption of ICD-10 will result in drastic changes in the way hospitals and physicians practice medicine. The increase in codes (going from 17,000 to 140,000) and the specificity of those codes will force the provider or biller to implement an electronic health record (EHR) or an electronic medical record (EMR). Currently, fewer than 25% of hospitals and 4% of physicians have fully functioning EHR/EMR systems.

In addition, the complexity and documentation requirements associated with claims coding will significantly impact the revenue cycle for hospitals and physicians. The initial implementation of ICD-10 will result in higher rates of claims rejection by the payers, and hospitals and physicians should expect their receivables to double.

This module discusses how payers can take advantage of this opportunity to build strong relationships with their provider communities by providing:

• Education on ICD-10 coding
  
• Consulting related to EHR/EMR system selection and implementation
  
• Coordinated testing of the billing/payment cycle
  
• Revenue cycle planning