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The Unknown Unknowns: What you don’t know can hurt you!

 

This is a first in a series blogs that we believe presents an excellent strategic approach forself assessment achieving every healthcare provider’s end-goal during the transition to ICD-10 -- ensuring there is NO reduction or stoppage of their revenue stream. Our mission is to see a stronger U.S. healthcare delivery system come out of this momentous transition.

Conduct knowledge gap assessments

This blog deals with how to develop and execute a strategic plan of action, and the first step in that plan is to assess the knowledge gaps in your clinical, administrative and coding staffs. What you don’t know can hurt you during this transition. The specific impacts of ICD-10 are hard to identify, but it is anticipated that due to multiple technical and clinical system interdependencies these impact will be very involved and serious.

The new code set is designed to provide benefits to patients, payers and providers, such as enhanced tracking and trending of diseases, innovations in payment design and contracting, improved care coordination, more effective case management and improved utilization management. These benefits come at the price of an increase in the number and specificity of diagnosis codes. The added complexity is evident in the increased specificity in coding injuries, additional codes for laterality and emphasis on affected body systems. Coders who are light on anatomy and physiology knowledge will have an increased learning curve adapting to ICD-10.

Organizations should perform a knowledge gap assessment as soon as possible and establish a training timeline to address how their staff members will handle the impact of the greatly expanded number of diagnosis codes in ICD-10. An effective “hands-on” staff training program should be started immediately.

Multiple programs will be affected by ICD-10

Almost every ongoing healthcare project will be affected by ICD-10. ARRA HITECH’s Stage 2 Meaningful Use requirements will be affected by ICD-10’s new data and specificity requirements. CMS will no doubt push healthcare providers to use ICD-10’s new codes in their efforts to prepare for future value-based reimbursement and accountable care programs.

Additionally, Clinical Documentation Improvement (CDI) initiatives will be affected. The best way for providers to assess the impact ICD-10 will have on this program is by analyzing their present CDI program. The key is adequate and relevant documentation. Documentation improvement initiatives can be conducted in conjunction with coder education in ICD-10-CM preparation. Documentation improvement will be the driver in successful integration of ICD-10-CM and will be less challenging with greater preparation. (We will have a specific blog later on the importance of CDI)

Estimate the potential for loss of coding productivity

Coding productivity losses are estimated at anywhere from ten to 70 percent as suggested by industry pundits. Your organization should start a coding health assessment by selecting an experienced coder, preferably with medium to strong clinical knowledge to code randomly selected cases with both ICD-9 and ICD-10 systems. Run the test for a period of approximately 30 days to gather data across a representative service and case mix. Measure the initial production patterns at the beginning stages of the pilot period and at the end. Identify the learning period, and as the coder reaches stable and familiar state see what he or she can optimally produce. Use these results to plan contingencies for interim coding support and long-term staffing changes.

Conclusion

There are three key preparation issues that if addressed properly, can help providers cope with the challenges of ICD-10:  knowing their practice service patterns, assessing their staff’s knowledge, and determining training needs. Being keenly aware of their practice operations, will allow providers to determine the top 80 percent of the ICD-9 codes they presently use, from this information they can devise cross-walks which will significantly reduce the ICD-10 conversion hassle. Providers should analyze their most frequently denied ICD-9 codes. Understanding these frequently denied -9 codes, will create a reference point from which to monitor similar codes in the new ICD-10 code set. Assessing staff knowledge -- coders, billing editors, denial resolution teams – will allow providers to benchmark the training needs for these critical positions. Remember, what you don’t know can hurt you!

Stay tuned -- next up – Dual Coding!

Don’t Let the Transition to ICD-10 “Stall Out” Your Revenue Cycle!

 

One of the worst things that can happen to an airplane pilot is to suffer a stall; that means -- more than likely -- a crash is imminent. Without proper planning, your revenue cycle is headed for a stall after the October 1, 2014 ICD-10 transition deadline. It’s critical that you devise a strategy NOW to avoid an ICD-10 claims backlog and a deadly stall for your accounts receivable.

The Centers for Medicare & Medicaid Services (CMS) has recommended that hospitals begin planning immediately for ICD-10, but so far, CMS reports many hospitals have not heeded their recommendation. This mistake can ultimately cause serious damage to hospitals’ revenue streams. CMS has also found in addition to having no transition plan in place, many hospitals have not begun any ICD-10 training, or work on their documentation improvement processes -- both of these activities are critical to the success of dealing with the new coding system.

Also according to  CMS, many healthcare providers have not even begun to consider the greatest threat to their facility’s revenue stream -- severe reductions to reimbursements caused by insurance claims backlogs. The increased granularity of the new ICD-10 coding system, which consists of almost 70,000 diagnosis codes as well as well over 72,000 procedural codes, will create the opportunity for potential errors in coding workflows and produce a tremendous backlog of claims. Even the most experienced coders are going to find this transition challenging.  CMS opined again in early September that hospitals should begin their planning process today. And, that effort should begin with a documented transition plan.  

Here are our recommendations for creating a viable ICD-10 transition plan. Your plan should include an ICD-10 readiness review. ICD-10 will mandate a huge change in your entire organization.  To deal with this change management, select a key person within your organization to be in charge of your ICD-10 transition project. This person’s responsibility will be to monitor all changes that will inevitably occur before and after the October 1, 2014 deadline, and report these activities to the rest of your staff. This individual will also be responsible for engaging key stakeholders to convince them ICD-10 compliance is critical to the financial health of your organization, and to ensure there is “a sense of urgency” within your organization to drive the necessary changes forward.

  1.      Understand how ICD-10 will impact your organization, enterprise-wide.

Your plan should include a gap assessment and analyses.  A gap assessment will help you gain an understanding of where and how ICD-10 will impact your organization. The assessment should include your people and their present expertise, your business processes and your legacy technologies to determine the impact of ICD-10, enterprise-wide. Any aspect of your organization that will be impacted by the ICD-10 transition should be carefully examined, including the programs and systems you are presently using for claims processing, analytics fraud detection, enrollment, eligibility and benefits. This gap assessment will let you know where you need to make proactive critical process changes before the deadline falls and your revenue is impacted.

2.           Take advantage of educational opportunities.

Specialty associations, such as AHIMA, AMA, MGMA, HIMSS and several billing associations will be offering training programs and information. Take advantage of these opportunities. Every organization is going to need some kind of training. The AAPC, a medical coding training and education association, expects that training will take about 50 hours for inpatient coders. People coding hospital charts will need to know both inpatient and diagnostic codes. The learning curve is going to be tremendous. E-learning programs that contain bite-size, easy to digest lesson presentations that your staff members can access any place they have Internet availability will have the least impact on their daily productivity. Industry webinars sponsored by various associations will focus on specific aspects of the ICD-10 transition. Monitor the topics of these webinars and ensure your staff members attend the appropriate ones.

Even after using good training programs, there will still likely be a backlog of claims. Your coders will be working more slowly because they are less familiar with the system. There is also an expectation, at least initially, that there will be more denials, which will take time to recode. You may want to consider enlisting outside help from expert sources who have been training for years to meet the challenges of ICD-10. They can help with your coding backlog and denial management.

Another educational exercise to consider is to identify and evaluate -- in advance of the ICD-10 deadline -- the potential high-risk codes and claims that will most likely have an impact on your specific revenue stream. These simulated ICD-10 claims can provide important data, enabling you to make critical financial analyses to your revenue stream before your coders ever begin working with ICD-10.  Conduct several tests on your simulated claims with your payers. Find out if they were accepted or denied. This information will allow you to proactively make needed changes within your organization to help ensure your financial well-being and stability during the transition.

3.            Enlist technology to help with your transition

Finally, don’t try to do everything on your own. Enlist technology to help you mitigate your financial risks. Technology is available today in the form of computer-assisted coding (CAC) tools.  CAC is a proven technology that automatically derives and assigns medical codes from within clinical documentation. Many are ICD-10-ready.

With this technology, your organization can “hit the ground running” and streamline your revenue cycle processes, while becoming increasingly more compliant with payer requirements and quality reporting. Some of the CAC technology vendors offer on-site coding expertise to ensure there is no lag in your coding workload. These technology solutions can work with your electronic health record (EHR) and financial systems to produce extremely accurate coding.

The benefits of CAC are many and you are going to need all the help you can get during this challenging time. These systems do not replace your professional coders; they just aid them and ensure improved accuracy, compliance, productivity and consistency, while your facility is “getting up to speed” on the new ICD-10 codes. This approach will alleviate the negative financial effects that will come from the October 2014 “hard cut over” deadline to the new system.

4.            Preventing Claims Backlogs Will Mitigate Your Financial Risk

The ICD-10 transition will have a tremendous impact on your organization and its revenue stream, and this impact will be felt for years after the ICD-10 migration has begun. Having a documented plan in place that will help you understand the impact on your revenue stream will go a long way toward mitigating any negative impacts. Taking advantage of the available educational programs will help you manage the ICD-10 transition and ensure the risk remediation programs you put in place can be maintained over time to mitigate future impacts to your revenue stream.  Finally, utilizing  a CAC tool, together with onsite coding assistance, will ensure your reimbursements and your revenue stream  survive the ICD-10 transition without experiencing a deadly stall.

 

A Primer for Managing the ICD-10 Transition

 

The healthcare industry is justifiably apprehensive about the impending transition from ICD-9 to ICD-10. Between claim denials from incorrect coding and coders taking more time to deal with the new system, billing is more than likely to slow down considerably. However, The Centers for Medicare and Medicaid (CMS) officials are saying that preparation and planning should keep providers’ accounts receivable from collapsing completely. The agency knows there are going to be claim denials, but they also contend there are ways to avoid many of them.

Two major challenges are going to impact billing after the transition begins. The first will be that ICD-10 requires a much more in-depth level of documentation.  A simple ED treatment such as a cut on a patient’s arm will require much more specificity in order to code and bill for the visit. For a simple open wound that requires a few stitches, coders will now have to drill down to whether it is a bite or other kind of wound, if there is or isn’t a foreign body involved, and exactly on which part of the body the wound is located – left or right arm.  As one can see, not only will the granularity of the coding increase, but the time to code will also increase.

Another challenge is that coders will have to spend more time examining documentation. Simply skimming a document will no longer suffice. The descriptors required for ICD-10 will be longer and include words like “with” or “without” which could easily be missed without an in-depth examination of the documentation. This is definitely going to impact a coder’s time and productivity will suffer.

However, this increased specificity will also bring advantages. ICD codes are also used for disease surveillance, monitoring and quality reporting.  Occurrences such as disaster recoveries, disease outbreaks and clinical trials all use ICD codes.  The increased specificity of ICD-10 data will provide more meaningful and useful data for these activities.

How can you be assured you are ready for ICD-10? The best way to defend your facility against the financial risks of this new mandate is to use the old sports adage: “The best defense is a good offense.” Following are some offensive tactics you should consider using:

* Plan

* Prepare

* Put new processes in place

* Have a financial contingency

* Test

Taking the offense with early planning and preparation can be your keys to a successful ICD-10 transition. If you have done everything you can to be prepared for the 2014 deadline, the chances are very good the transition will have a minimal impact on your organization and its revenue stream. Hope for the best and good luck!

A Guide for the Safari through the ICD-10 Jungle

 

The American Hospital Association (AHA) Central Office director of coding and classification Nelly Leon-Chisen, RHIA, has authored the 2014 edition of the ICD-10-CM and ICD-10-PCS Coding Handbook, which was published recently and is now available.

The new 2014 Handbook follows the popular Faye Brown edition style. Key features include Coding Clinic ICD-10-CM/PCS advice and clarification on "gray areas," more than 60 new exercises and case studies, engaging illustrations and visual elements, and a built-in workbook of case summary exercises. The 2014 Handbook reflects the most recent versions of the Official Coding Guidelines, including the latest updates from the Cooperating Parties.

According to the AHA, because of Leon-Chisen's close involvement with the ICD-10-CM/PCS code sets, the new Handbook contains the most accurate and up-to-date ICD-10-CM/PCS information available. Leon-Chisen encourages use of the Handbook as a training tool and reference. She advises that, "With ICD-10-CM/PCS coding changes just around the corner and effective October 1, 2014, it is imperative that organizations do what they need to do now to prepare."

We could not agree more.

If you are not truly concerned about the financial risks of transitioning to ICD-10, you should be! Nearly every aspect of your healthcare delivery process will be impacted by this transition, including reimbursements, quality of patient care, your overall costs, and several other critical aspects of your financial and clinical workflows. Unless you have a plan of action to mitigate those risks, your revenue is going to be severely impacted, possibly to point of devastation.

How might your revenue stream be affected? Simply put: by severe increase in delays and denials! The increased granularity of the new ICD-10 coding system, which consists of well over 70,000 codes, will create the opportunity for potential errors in your coding workflow. Even your most experienced coders are going to find this transition challenging. Being well conversed in the new codes outlined in the AHA Coding Handbook will help tremendously, but here are four additional steps you can take to mitigate your risks:

1. Create a plan that includes an ICD-10 readiness review.

ICD-10 will mandate a huge change in your entire organization. This change will require a documented plan and strategy to ensure your ICD-10 compliance transition is successful. To deal with this change management, select a key person within your organization to be in charge of your ICD-10 transition project. This person’s responsibility will be to monitor all changes that will inevitably occur before and after the October 2014 deadline, and report these activities to the rest of your staff. This individual will also be responsible for engaging key stakeholders to convince them that ICD-10 compliance is critical to the financial health of your organization, and to ensure there is “a sense of urgency” within your organization to drive the necessary changes forward.

2. Understand how ICD-10 will impact your organization, enterprise-wide

Your plan should include a gap assessment and analyses.  A gap assessment will help you gain an understanding of where and how ICD-10 will impact your organization. The assessment should include your people and their present expertise, your business processes and your legacy technologies to determine the impact of ICD-10, enterprise-wide. Any aspect of your organization that will be impacted by the transition to ICD-10 should be carefully examined, including the programs and systems you are presently using for claims processing, analytics fraud detection, enrollment, eligibility and benefits. This gap assessment will let you know where you need to make proactive critical process changes before the deadline falls and your revenue is impacted.

3. Take advantage of educational opportunities.

Specialty associations, such as AHIMA, AMA, MGMA, AHA, HIMSS and several billing associations will be offering training programs and information. Take advantage of these opportunities. Every organization is going to need some kind of training. The learning curve is going to be tremendous. Online educational programs that your staff members can access any place they have Internet availability will impact their daily productivity the least. Industry webinars sponsored by various associations will focus on specific aspects of the ICD-10 transition. Monitor the topics of these webinars and ensure your staff members attend the appropriate ones.

Another educational exercise that you might want to consider is to identify and evaluate the potential high-risk codes and claims that will most likely have an impact on your specific revenue stream -- in advance of the ICD-10 deadline. These simulated ICD-10 claims can provide important data, enabling you to make critical financial analyses to your revenue stream before your coders ever begin working with ICD-10. This information will allow you to proactively make needed changes within your organization to help ensure your financial well-being and stability during the transition.

4. Enlist technology to help with your transition

Finally, don’t try to do everything on your own. Enlist technology to help you mitigate your financial risks. Technology is available today in the form of computer-assisted coding (CAC) tools.  CAC is a proven technology that automatically derives and assigns medical codes from within clinical documentation. Many are presently ICD-10-ready.

With this kind of technology, your organizations can “hit the ground running” and streamline your revenue cycle processes, while becoming increasingly more compliant with the requirements of payer and quality reporting. Some of the CAC technology vendors even offer on-site coding expertise to ensure there is no lag in your coding workload. These technology solutions can work with your electronic health record (EHR) and financial systems to produce extremely accurate coding.

The benefits of CAC are many and you are going to need all the help you can get during this trying period. These systems do not replace your professional coders; they just aid them and ensure improved: accuracy, compliance, productivity and consistency, while your facility is “getting up to speed” on the new ICD-10 codes. This approach will alleviate the negative financial effects that will come from the October 2014 “hard cut over” deadline to the new system.

Mitigating Financial Risk

The transition to ICD-10 will have a tremendous impact on your organization and its revenue stream, and this impact will be felt for years after the ICD-10 migration has begun. Being well acquainted with the new, greatly expanded coding structure and having a documented plan in place -- that will help you understand how your specific revenue stream will be affected -- will go a long way toward mitigating any negative impacts. Taking advantage of the educational programs that are available will help you manage the ICD-10 transition and ensure that the risk remediation programs you put in place can be maintained over time to mitigate future impacts to your revenue stream. And finally, employing some form of CAC tool, possibly with onsite coding expertise, will ensure your reimbursements and your revenue stream will survive the transition to ICD-10.

For more information or to reserve a copy of the New AHA Coding Handbook, please visit: http://www.ahacentraloffice.org  or call 800-242-2626.

The Switch to ICD-10 Will Not Be All “Gloom and Doom!”

 

There is a definite upside to this change-over.

Good preparation for the “so-called” transition to ICD-10 coding can actually optimize your reimbursements; it is going to take some effort, but it can pay off in terms of higher practice revenue, less paperwork and greater overall clinical efficiency. Preparation is the key, but it will provide an excellent ROI!

The term transition does not really apply to what is going to happen on October 1, 2014. It will not be a gradual, step-by-step movement to the new coding system; it will be a complete and immediate hard cut-over when that date rolls around.

The Centers for Medicare & Medicaid Services (CMS) continues to warn healthcare providers that preparation and training are necessary, but according to their research, they find little evidence that is happening.

How did we get to where we are today?

The attempt to classify diseases goes back to the late19th century. However, using those classifications, as the basis to determine reimbursement levels, did not come into play until the Federal government became a major payer in the healthcare industry. The 10th revision of this classification system covers more than 14,400 distinct codes, and the ICD-10-PCS contains more than 76,000. Some of the new codes are ludicrously specific, such as injuries sustained by a collision with a sea lion and its associated complications.

Education on how ICD-10 codes fundamentally differ from the current system will be critical. For example, ICD-10 procedure codes have seven positions, expanded from five positions in the ICD-9-CM code set. Example: XXX.XXXX = 7 character possible code. All codes must be at least 3 digits and a decimal point separates the 3rd and 4th characters. The placeholder x is employed for codes using the 7th character, but not the 5th or 6th characters, x can be used to mark the character's place in the code without giving it a value. Here’s an example: T75.4xxA = electrocution, shock from electric current, shock from electroshock gun (taser), initial encounter. The 7th character defines encounter:  initial encounter, subsequent encounter, sequela.

Because ICD-10 codes are so different from ICD-9-CM codes, and not just an expansion of that system, it is important for healthcare providers who must use them to develop a working familiarity with the new code set.

Every healthcare provider should have their coding staff examine their current top 10 ICD-9-CM codes, along with their current documentation. Verify, with hand-on practice, that your coders can readily convert ICD-9 codes to the new ICD-10 system based on their current documentation. If they can’t, identify which critical pieces of information are missing in the your current documentation? Making these documentation improvements - now - will minimize the potential revenue impact on October 1, 2014.

Even if your facility has an excellent coding staff and a great billing department, the chances are pretty good that your coding productivity and your revenue stream are going to “take a hit.”

Several suggestions have been put forward on to deal with this cash flow impact. The HIMSS ICD-10 PlayBook, a blueprint for provider and payers’ ICD-10 implementation, recommends that providers have a minimum of six months of cash reserves to mitigate revenue impacts during the ICD-10 transition period; how healthcare providers have this kind of cash on hand?

How much emergency cash should your organization have in reserve to manage the ICD-10 disruptions to payments during the transition?  Since your expenses and cash outlays will remain the same, and may even increase during the transition, some industry experts are suggesting you have some amount of cash reserves, or at least, access to cash through loans or lines of credit to avoid potential problems.    

To meet these revenue disruption challenges, healthcare providers should also be considering the use of new technology. Technology is available today in the form of computer-assisted coding (CAC) tools.  CAC is a leading-edge technology that automatically derives and assigns medical codes from within clinical documentation. Many are presently ICD-10-ready.

With this kind of technology, your organizations can “hit the ground running” and streamline your revenue cycle processes, while becoming increasingly more compliant with the requirements of payer and quality reporting.   Many CAC technology vendors offer on-site coding expertise to ensure there is no lag in your coding workload. These technology solutions can work with your electronic health record (EHR) and financial systems to produce extremely accurate coding.

Adequate preparation and training are crucial to minimizing your financial impact. If you have yet to develop an implementation plan, there is still time, but you should act now.

The first step is to assess your vulnerability. In order to understand how ICD-10 will impact your organization, enterprise-wide, you should plan to conduct a readiness review that includes a gap assessment and analysis.  A gap assessment will help you gain an understanding of where and how ICD-10 will impact your organization.

The assessment should include your people and their present expertise, your business processes and your legacy technologies to determine the enterprise-wide impact of ICD-10. Any aspect of your organization impacted by the transition to ICD-10 should be carefully examined, including the programs and systems you are presently using for claims processing, analytics, fraud detection, enrollment, eligibility and benefits verification. This gap assessment will let you know where you need to make proactive critical process changes before the deadline falls and your revenue is impacted.

Take advantage of every educational opportunity.  Specialty associations, such as AHIMA, AMA, MGMA, HIMSS and several billing associations will be offering training programs and informational webinars. Monitor these webinar topics and ensure your staff members attend the appropriate ones. Every organization is going to need some kind of training. The learning curve is going to be tremendous. Targeted, e-learning programs that your staff members can access any time and any place they have Internet availability will least impact their daily productivity.

The Switch to ICD-10 does not have to be all gloom and doom. With good preparation you should be able to actually improve your reimbursements, but it’s going to take some effort. These proactive efforts will pay off in terms of higher practice revenue, less paperwork and greater overall clinical efficiency. Preparation is the key, but it will provide an excellent ROI -- instead of dooms day!

 

A Tool that Can Aid in Your ICD-10 Transition

 

Seldom has any mandate or compliance regulation had the potential to disrupt, so severely, the revenue stream of almost every healthcare provider. The transition to ICD-10 is going to require one of the most intense and longest learning curves in the history of U.S. healthcare. As everyone is aware, proper coding of the care delivered is critical to your reimbursements.Moving from ICD-9 to ICD-10 is going to be a giant leap -- not a baby step.

A survey reported in the 8/14/13 edition of HISTalk claims only 38 percent of providers participating in the survey were at least somewhat confident in their practice’s ability to transition to the ICD-10 code set. This tells me that healthcare providers are going to need all the help they can muster to make this leap. This help should include a documented plan of action, intensive training, outside consulting services, new technologies or some combination of all of these. You are going to need the courage to start planning as soon as possible and seek help as necessary! Procrastination will not delay the impending deadline and its resulting impact on your revenue stream.

In regard to ICD-10 assistance from available technologies, changes in medical coding automation have made excellent strides in recent years. Today, computer-assisted coding (CAC) tools are proven technologies that can automatically identify and assign medical codes from within your clinical documentation with astounding accuracy.

Many are ICD-10 ready right now!

This technology can infuse the immediate expertise you need to streamline your organization’s coding processes, while your staff gets “up to speed” on handling the new codes on their own. This will give you time to become increasingly more compliant with the new requirements of payer and quality reporting.  Most CAC technologies can be integrated into your electronic health record and financial systems producing vast financial benefits and productivity gains.

Your coders should not be concerned that they will be replaced by CAC. It is simply another tool for your ICD-10 transition work plan. CAC, although very accurate, will always need to be reviewed and verified by expert coding professionals. CAC simply injects automation into the process. It can never be the final authority on the correct code. It can, however, relieve workloads and provide expertise to help coders do their jobs more productively and efficiently.

The rapid growth of CAC in today’s healthcare delivery process is due to the significant benefits it provides:

•    Improved accuracy

There is a significant improvement in accuracy. Many systems on the market today offer accuracy rates in the 97+ percent range.  Think about what a first pass coding rate of this magnitude can do for your organization and your coders’ productivity after the ICD-10 deadline becomes a reality. What will these results do for your coders in terms of decreasing denial rates, reducing auditing discrepancies and finding lost charges. A tool that can increase your accuracy rate will help your organization capture charges that would otherwise be lost during the transition.

•    Improved compliance right out of the box

By getting it right the first time with the aid of CAC, you will improve your compliance efforts. Since coding is accurate and consistent to begin with, your reworks will be reduced and your compliance will be constant.

•    Improved consistency

Consistency is a must throughout the coding process.  Without consistency that ensures guidelines are met, problems arise.  Consistency will create confidence in your staff and in your coding processes. This will also provide more accurate results for both clinical and financial analyses. 

•    Improved productivity

CAC will improve your productivity significantly.  Many hours spent manually coding can be reduced significantly with excellent accuracy rates.

Take advantage of everything that can help you mitigate your ICD-10 transition risks – planning, in-depth training, expert consulting, and CAC tools. Don’t be afraid to ask for help. The consequences of not being prepared are too great!

 

5 Practical Ideas to Aid in Your ICD-10 Transition

 

Everyone in healthcare, who deals with coding, is keenly aware of the October 2014 deadline that is looming over the industry. Some are facing it head-on; others seem to be ignoring it, hoping it will just go away. No matter where you stand on the timeline or on your journey toward ICD-10 preparedness, here are 5 practical ideas that can help you cope with this challenge.

It goes without saying that ICD-10 will require a huge learning curve. The challenge is to face that learning curve and get-up-to-speed on the new coding -- without having your revenue cycle impacted or disrupted.

1.    Create a Roadmap for Success with an ICD-10 Readiness Review

ICD-10 will require a huge change in your entire organization. This change will require a documented strategy or roadmap to ensure your compliance journey is successful. To deal with this change management process, select a person who will be in charge of your ICD-10 transition project. This person’s responsibility will be to monitor all changes that will inevitably occur before the deadline, and report these activities to the rest of your staff. This individual will also be responsible for engaging key stakeholders to convince them that ICD-10 compliance is critical to the financial health of your organization, and to ensure there is a sense of urgency within your organization to drive the necessary changes forward.

2.    Conduct a High Level Review with a Gap Assessment and Analyses

A gap assessment will help you gain an understanding of where and how ICD-10 will impact your organization. The assessment should include your people and their expertise, your business processes and your technology to determine the impact of ICD-10, enterprise-wide. Any part of your organization that will be impacted by ICD-10 such as, the programs and systems you are presently using for claims processing, analytics fraud detection, enrollment, eligibility and benefits. This gap assessment will let you know where you need to make critical process changes before the deadline falls and your revenue is impacted.

3.    Take advantage of educational opportunities.

Specialty associations, such as AHIMA, AMA, MGMA and several billing associations will be offering training programs and information. Take advantage of these opportunities. Every organization is going to need some kind of training. The learning curve, as stated previously, is going to be tremendous. Online educational programs that your staff members can access any place they have Internet availability will impact their daily productivity the least. Industry webinars sponsored by various associations will focus on specific aspects of the ICD-10 transition. Monitor the topics of these webinars and ensure your staff members attend the appropriate ones.

4.    Enlist technology to help with your transition

Finally, don’t try to do everything on your own. Enlist technology to help you on your journey. Technology is available in the form of computer-assisted coding (CAC) tools.  CAC is a proven technology that automatically derives and assigns medical codes from within clinical documentation. Many are already ICD-10-ready.

Your organizations can streamline your revenue cycle processes with CAC, while becoming increasingly more compliant with the requirements of payer and quality reporting.  These technologies can work with your electronic health record and financial systems to produce extremely accurate coding. The benefits are many and you are going to need all the help you can get. These systems don’t replace your professional coders; they just aid them and ensure improved: accuracy, compliance, productivity and consistency.

5.    Implementation and ICD-10 Compliance

The final steps in your journey to ICD-10 compliance require the implementation of your revised business processes that were uncovered during the gap assessments. This is easier said than done.  No organization can start from scratch when it comes to dealing with their legacy IT systems. You are going to have to work with the technology you have presently installed, with possibly of a few additions. You may also want to enlist outside coding help for a period of time to ensure your coders have the expertise to handle the increased workload under the new coding system. When you are satisfied your staff can do everything on its own, you can go it alone.

Using the combination of your legacy IT systems and new technologies, coupled with your new coding expertise, gained through training, and your newly implemented business processes will lead to an ICD-10 transition that will have minimal impact on your revenue cycle.

           

 

Beware of Errant Sea Lions!

 

It is highly unlikely you will be hit by a sea lion – new ICD-10 code W5612XA, but it’s a sure thing your revenue stream will take a devastating blow if you are not fully prepared for the transition to the new ICD-10 coding set. The code mentioned in the previous sentence is just one example of the seemingly ludicrous granularity of the new ICD-10 codes. This increased specificity, which offers well over 70,000 codes, will create an overwhelming potential for errors in your coding workflow. Even your most experienced coders are going to find this transition challenging.

A survey reported in the 8/14/13 edition of HISTalk claims only 38 percent of providers participating in the survey were at least somewhat confident in their practice’s ability to transition to the ICD-10 code set. This indicates we still have a “long road to travel with a short time to get there.”

You need a plan in to mitigate the risks to your organization’s revenue stream

The first element of your plan should be a readiness review. Only with this kind of information can you determine where your organization stands in its preparedness for ICD-10. This new code set will mandate a huge change in your entire organization. To deal with this change management, select a key person within your organization to be in charge of your ICD-10 transition project. This person’s responsibility will be to monitor all changes that will inevitably occur before and after the deadline of October 2014, and report these activities to the rest of your staff. This individual will also be responsible for engaging key stakeholders to convince them that ICD-10 compliance is critical to the financial health of your organization, and to ensure there is “a sense of urgency” within your organization to drive the necessary changes forward.

Understanding how ICD-10 will impact your organization, enterprise-wide

Your readiness plan should include a gap assessment and analyses.  A gap assessment will help you gain an understanding of where and how ICD-10 will impact your organization. The assessment should include your people and their present expertise, your business processes and your legacy technologies to determine the impact of ICD-10, enterprise-wide. Any aspect of your organization that will be impacted by the transition to ICD-10 should carefully examined, including the programs and systems you are presently using for claims processing, analytics fraud detection, enrollment, eligibility and benefits. This gap assessment will let you know where you need to make proactive critical process changes before the deadline falls and your revenue is impacted.

Take advantage of educational opportunities

Specialty associations, such as AHIMA, AMA, MGMA and several billing associations will be offering training programs and information. Take advantage of these opportunities. Every organization is going to need some kind of training. The learning curve, as stated previously, is going to be tremendous. Online educational programs that your staff members can access any place they have Internet availability will impact their daily productivity the least. Industry webinars sponsored by various associations will focus on specific aspects of the ICD-10 transition. Monitor the topics of these webinars and ensure your staff members attend the appropriate ones.

Enlist technology to help with your transition

Finally, don’t try to do everything on your own. Enlist technology to help you mitigate your financial risks. Technology is available today in the form of computer-assisted coding (CAC) tools.  These tools automatically derive and assign medical codes from within clinical documentation. Many are presently ICD-10-ready.

With this kind of technology, your organizations can “hit the ground running” and streamline your revenue cycle processes, while becoming increasingly more compliant with the requirements of payer and quality reporting. Additionally, some of the CAC technology vendors offer on-site coding expertise to ensure there is no lag in your coding workload. These types of technology solutions can work with your electronic health record (EHR) and financial system to produce extremely accurate coding.

The benefits of CAC tools are many and you are going to need all the help you can get during this trying period. These systems do not do away with your professional coders; they just aid them and ensure improved: accuracy, compliance, productivity and consistency, while your facility is “getting up to speed” on the new ICD-10 codes. This approach will alleviate the negative financial effects that will come from the October 2014 “hard cut over” deadline to the new system.

Mitigating Your Financial Risk

Suffering and ill effects of being hit by a “crazed” sea lion are doubtful, but you can count on the transition to ICD-10 having a tremendous impact on your organization and its revenue stream, and this impact will be felt for years after the ICD-10 migration has begun. Having a documented plan in place that will help you understand how your revenue stream will be affected will go a long way toward mitigating any negative impacts. Taking advantage of the educational programs that are available today will help you manage the ICD-10 transition and ensure that the risk remediation programs you put in place can be maintained over time to mitigate future impacts to your revenue stream, long after the ICD-10 deadline has passed. And finally, employing some type of CAC tool, possibly with onsite coding expertise, will mitigate the risks to your reimbursements and your revenue stream as you cope with the transition to ICD-10.

 

 

 

 

 

Is Your Vendor Ready to Help with Your ICD-10 Transition?

 
 

Key Questions to Ask

The transition to ICD-10 is going to be a monumental task.  In our opinion, almost no healthcare organization will be able to reach ICD-10 compliance without help from healthcare technology vendors.

The Centers for Medicare and Medicaid Services (CMS) sent out a list of questions that can help healthcare organizations assess vendor's readiness capabilities:

  • Do your current vendor contracts cover your practice's ICD-10-related needs?

  • What is the vendor's timeline for the ICD-10 transition?

  • Will your vendor install products well before the October 1, 2014, deadline, so you can begin testing them in 2013?

  • Has your vendor scheduled with you to test your system with your trading partners?

  • Will all your vendor's current products and applications be updated for ICD-10?

  • Has your vendor scheduled training for your staff on the ICD-10 system updates?

  • Do your vendor’s products give you the ability to search for codes by the ICD-10 alphabetic and tabular indexes? By clinical concept?'

  • Will your vendor’s product allow for coding in both ICD-9 and ICD-10 to accommodate transactions with dates of service before October 1, 2014, and transactions with dates of service after October 1, 2014?

Additionally, make sure you have someone in-house to manage your side of the ICD-10 transition.  Your vendor will be a key partner, but you need to ensure your facility is doing everything it can to support your vendor in meeting your transition needs.

As a result of the answers to the above questions, if you discover your present vendor will not be able to meet your transition needs, the following questions will help in your search for a potential, new vendor; they are slightly different:

  • Will your products be ready for the ICD-10 compliance date?

  • How does your product simplify my organization's transition to ICD-10?

  • How does the functionality offered by your system compare with my current system?

  • Does your implementation require a complete system conversion?

  • Based on what I already have in place, how much will it cost to convert to your system?

  • What are the costs of maintenance for your product?

  • Will there be training on your products?

-- Does training cost extra?

-- How much time will training take?

  • What other healthcare organizations are currently using your products/services?

Hopefully these questions will help you assess the readiness of your present vendor and/or help you in your search for a new ICD-10 transition partner.

5 Key Strategies for Optimizing Revenue Cycle Performance

 

In today’s healthcare economic climate, the majority of healthcare providers are acutely interested in optimizing their revenue cycle performance. The first aspect to be considered is -- where is the best place to start? It is also important to remember that revenue cycle performance improvement is a journey, not a destination.
 

Another point to consider is that it is much more cost-effective and easier to improve cash collections and liquidity on current patient revenue than it is to find new revenue streams or drive new patients to your facility. Once you have supplied services for a patient, every dollar – possible -- should be collected. Some industry experts estimate that hospitals are losing from three to five percent of their net revenue from inadequate revenue cycle management processes and procedures. Capturing revenue from all payer sources has become of paramount importance. The largest amount of revenue losses are often the direct result of poor data capture at the front-end of the revenue cycle and operational inefficiencies. A smaller but still significant amount of losses come from unidentified or undetected government and commercial revenue sources that end up in the self-pay financial class and eventually go uncollected.
 

Bad debt continues to rise as patients take greater risk by choosing higher deductible health plans to reduce their overall out-of-pocket costs. Even with the advent of healthcare reform, many patients are forced to under insure themselves or go without insurance all together.
 Aside from the self-pay collection process challenges , hospitals are plagued by the rising costs and financial repercussions of performing revenue cycle activities, such as handling insurance payment rejections and denials, identifying lost charges, delayed payments, underpayments, and the hidden costs of reworks.
 

Healthcare providers are continually searching for new tools and technologies, which offer end-to-end solutions to boost revenues and operational efficiencies across their entire revenue cycle. No longer are the current “bolt on” single technology solutions acceptable as a stopgap solution in today’s complex environment. Healthcare executives are looking for cost-efficient, overarching strategies and technology solutions, which complement their current systems and processes, and provide the business and operational intelligence data needed to optimize financial and operational performance.

The first steps that should be taken to identify performance improvement opportunities are:

  • Assess and map the current state of your revenue cycle
  • Identify key challenges and the systemic causes of these challenges
  • Brainstorm with your financial staff strategic and tactical solutions to these challenges
  • Outline best practices technologies, review the possibility of outsourcing some or all of your RCM, and redesign your processes to meet these challenges

Once your revenue cycle challenges are identified, employing the following five key strategies offers proven results for enhancing your revenue cycle performance:

  1. Employ Business Operational Intelligence
  2. Ensure Physician Order Communication is viable
  3. Institute a Medical Necessity Screening process
  4. Establish a Zero Error and Defect in Registration Quality
  5. Create efficient and viable POS and Self-Pay Collection procedures.

The benefits of implementing these strategies are:

  • Ability to track any performance metric to ensure top performance
  • Maintaining a seamless flow of information within the revenue cycle
  • Increased information accuracy
  • Decreased denials
  • Decreased manual effort to bill and collect
  • Better accuracy and communication between referring physician offices and the hospital
  • Improved patient satisfaction ratings

 

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