Kodiak data from more than 2,300 hospitals shows that IC and IR services account for nearly 13% of hospital revenue

INDIANAPOLIS: #healthcare--Hospitals are racing to meet a January 1 deadline to adjust to billing code changes that affect invasive cardiology (IC) and interventional radiology (IR) services, two lines of business that account for nearly 13% of hospital revenue, according to a Kodiak Solutions analysis.

Hospitals, health systems and medical practices first learned of the potential changes in July, when the Centers for Medicare & Medicaid Services (CMS) issued proposed rules for hospital outpatient prospective payments and the physician fee schedule for calendar year 2026. The physician fee schedule rule was finalized on Oct. 31. All IC and IR claims must use the new codes as of January 1, with no grace period.

For IC procedures, 10 existing codes have updated descriptions or definitions, eight codes will be eliminated and two new codes have been introduced. For IR procedures, 16 codes will be eliminated and 46 new codes are going into effect. In total, there are about 160 IC codes and 300 IR codes.

“From physicians and coders to revenue cycle teams, these new codes affect clinical, operational and financial decisions made for scores of procedures each and every day,” said Matt Szaflarski, Vice President, Revenue Cycle Intelligence, for Kodiak Solutions.

For revenue cycle leaders in particular, the stakes are high. As noted, IC and IR procedures account for nearly 13% of hospital revenue on average for the 2,300 hospitals that provide data for the Kodiak Solutions Revenue Cycle Analytics platform.

Kodiak analysis shows higher rate of initial denials

Kodiak’s analysis of these proprietary data also show that IC and IR procedures have a higher rate of initial denials by insurance companies over the past 12 months. The measure used is the amount of gross patient service revenue of initially denied claims as a percentage of all gross patient service revenue for IC and IR procedures, compared with the gross patient service revenue for all denied outpatient claims as a percentage of revenue from all outpatient claims.

The monthly initial denial rates for IC and IR claims over the past 12 months were 0.3 percentage points to 1.5 percentage points higher than the monthly initial denial rates for all outpatient claims, according to Kodiak’s analysis.

“The analysis suggests insurers are giving IC and IR claims an incredible amount of scrutiny,” Szaflarski said. “That raises the stakes for hospitals, health systems and medical providers to properly implement these new codes.”

The analysis also shows that the final denial rate for IC and IR claims is significantly lower than for outpatient claims as a whole. Revenue cycle teams have to put in a lot of work to reverse those denials, and that cost, as well as the cash flow hit of delayed payment, are financial challenges for hospitals and health systems, Szaflarski said.

Revenue cycle and finance teams need to lead effort to adopt new codes

Szaflarski said increasing denials aren’t inevitable, despite the short turnaround time for making these changes. Some steps revenue cycle and finance leaders can take include:

• Launching a closely coordinated effort to implement the new codes with counterparts in information technology, information systems and coding.

• Drawing on revenue cycle and finance experts to train coders and clinicians on the aspects of these changes that affect their respective workflows.

• Updating prior authorization and precertification protocols for the new codes, developing contingency plans for payors who are late to adopt the new codes, and monitoring the performance of the new codes by payor to be alert to denial challenges.

Benchmark data provide the rule for measuring performance on implementing the new IC and IR codes, Szaflarski added, with key performance indicators such as gross revenue, initial denial rates and more granular data on the reasons for initial denials, and coding accuracy as measured by retrospective reviews.

More details about these code changes and an analysis of how insurers treat IC and IR claims can be found in the quarterly Kodiak RCA Benchmarking Analysis.

About Kodiak Solutions

Kodiak Solutions is a leading technology and tech-enabled services company that simplifies complex business problems for healthcare provider organizations. For nearly two decades as a part of Crowe LLP, Kodiak created and developed our proprietary net revenue reporting solution, Revenue Cycle Analytics. Kodiak also provides a broad suite of software and services in support of CFOs looking for solutions in financial reporting, reimbursement, revenue cycle, risk and compliance, and unclaimed property. Kodiak’s 450 employees engage with more than 2,300 hospitals and 350,000 practice-based physicians, across all 50 states, and serve as the unclaimed property outsourcing provider of choice for more than 2,000 companies. To learn more, visit our website.

Fonte: Business Wire