GeBBS Healthcare Blog

Allison Jones

Recent Posts

Avoid a Shutdown of Your Revenue Cycle during the Transition to ICD-10

Posted on Tue, Dec 10, 2013 @ 09:40 AM

Early test results reported in Becker’s Hospital Review from data gathered by HIMSS and WEDI indicate that only 63% of ICD-10 documentation was accurately coded.   In addition, coders averaged only two medical records per hour, compared with four per hour under ICD-9, which equates to a 50 percent drop in productivity.

The results came from the ICD-10 national pilot program, which started in April 2012 and ended in August 2013. The Healthcare Information and Management Systems Society (HIMSS) and Workgroup for Electronic Data Interchange (WEDI) released a report on the program, and the groups said ICD-10 coding accuracy varied wildly depending on what was being coded.

CMS officials are saying that good preparation and planning can keep providers’ accounts receivable from shutting down completely during the transition to ICD-10. The agency knows there are going to be claim denials, but they also contend there are ways to avoid many of them.

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.

Include CMS policies in your plan. To deal with this critical 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. This individual should obtain as much information as possible from CMS before the conversion begins. CMS is currently rewriting its coverage determination policies and will be assisting local carriers. Medicare policies are also expected to be completed before the go-live date. If you have a heavy Medicare population, get this information as soon as it becomes available and work through the new policies. Expect the worst and prepare your staff to meet this challenge.

Education on ICD-10 is going to be critical. 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 learning curve is going to be tremendous. Targeted, 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.

Put new processes in place to help you deal with the transition. 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. 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.

Examine your in-house capabilities; if there isn’t enough staff bandwidth to deal with the transition, enlist help. 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.

Several sources, including CMS are suggesting that you have a financial contingency plan in place. The HIMSS ICD-10 PlayBook, a blueprint for provider and payers’ ICD-10 implementation, recommends that providers should have a minimum of six months of cash reserves to mitigate revenue impacts during the ICD-10 transition period.

Even CMS has stated you can count on delays in your reimbursements, so having access to cash reserves may not be a bad idea. 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.

Test you claims submissions and communicate with your payers. Identifying your most-used and high- risk claims, and testing their coding accuracy will enable you to make critical financial analyses to your revenue stream before you 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.

Communicate with your healthcare payers and clearinghouses.  Do not wait until you submit your first ICD-10 coded claim to communicate with your payers. Early communication will help you test the ICD-10 claims process and gain insight into how reimbursements will be affected after Oct. 1, 2014. There will be a hefty price tag for procrastination.

You can avoid a shutdown of your revenue cycle with early planning and preparation. 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. 

Tags: Medical Coding, ICD-10, Revenue Cycle Management (RCM)

Weak Revenue Cycle Management Can Spawn Many Problems

Posted on Tue, Dec 03, 2013 @ 10:31 AM

The effects of weak revenue cycle management can go well beyond just financial challenges. Revenue problems can also lead to patient dissatisfaction challenges, and this can lead to reimbursement problems. Why do so many hospitals experience problems with their revenue cycle? A good explanation is that busy healthcare providers are challenged to keep abreast with the rapidly changing and complex payer requirements for pre-authorizations, medical necessity checking, new coding mandates, accurate charge capture, reporting requirements and a plethora of other financial challenges. This is compounded by the rise in self-pay patients and the inefficient data that supports the collection of these accounts. In general, many providers just don’t have the time to efficiently and effectively monitor their revenue cycle across the enterprise.

The key differentiator of the best-performing revenue cycle managers from those who deliver weaker results is the ability to think “outside the box” and seek new ways to improve their cycle management processes. They have the ability to envision how their revenue cycle can operate more successfully and adopt strategies that will help them achieve peak performance.

Top performing managers find creative ways to improve their performance.  They continually evaluate new techniques by measuring the net return of new cycle performance strategies/techniques. By following this forward-thinking approach, they are able to deliver financial results that other revenue cycle managers cannot.

These forward-thinking managers identify performance improvement opportunities such as:

  • Assessing and mapping the current state of their revenue cycle
  • Identifying key challenges and the causes for revenue leakages
  • Brainstorming strategic and tactical solutions
  • Exploring new best practices, including outsourcing portions of their cycle management where they need help
  •  Redesigning cycle processes

After these managers identify opportunities for improvement, they begin to execute  strategies to improve revenue cycle performance by leveraging what they have learned and by adopting new techniques/strategies for handling: eligibility and benefits verification, medical necessity checking, registration processes, charge capture, coding, payment posting, A/R follow-up and effective point of service (POS) and self-pay collections.

 Implementing these new strategies provides an overall increase in the revenue stream with:

•             Reduced downstream problems, including delayed payments, reworks and fewer errors

•             Improved flow of information throughout the revenue cycle

•             Increased visibility and charge data accuracy

•             Decreased denials

•             Decreased manual effort to bill and collect POS

•             Improved coding accuracy

•             Enhanced patient satisfaction

The costs of faulty revenue cycle management are far-reaching. The successful application of leading-edge revenue cycle strategies requires new thinking across the entire cycle. To sustain your revenue cycle quality and performance, you will need to secure buy-in from all the departments involved. Money isn’t the only reason to consider evaluating your revenue cycle’s performance. Patient satisfaction usually goes hand in hand with how you handle your financial operations. More often than not, if you are experiencing a revenue cycle performance problem, you also have a patient satisfaction problem.

Tags: Accounts Receivable (A/R), Revenue Cycle Management (RCM), Insurance Billing Solutions

Don’t Overlook Clinical Documentation in Your ICD-10 Preparations

Posted on Tue, Nov 26, 2013 @ 10:29 AM

Is your clinical documentation ready for ICD-10? CMS has prepared a guide called Simple Steps to Improve Clinical Documentation; it’s worth your time to review it.

This little document is good place to start your preparation for ICD-10 implementation activities. By improving clinical documentation now, you will be ready to assign ICD-10 codes when the deadline hits.

Your time won’t be wasted between now and Oct. 1, 2014, and you will realize the following benefits:

  • Complete and accurate medical records that ensure patients receive the right treatment.
  • Your coders will be assigning the proper medical codes which will lead to fewer physician queries and improved medical billing and clinical workflows.
  • Fewer claims rejections because of improper coding and not enough documentation to support diagnoses.
  • Improved clinical documentation that makes it easier to protect against healthcare fraud and disputed fraud charges.

Practice ICD-10 coding with real cases. This will help everyone -- from the office staff to clinicians to medical coders -- understand where current documentation falls short. Dual coding will be a time-consuming and expensive exercise but a valuable way to demonstrate your CDI needs.

In addition, clinical documentation improvement (CDI) makes computer-assisted coding (CAC) systems work more efficiently. Enlisting technology to help you on your ICD-10 journey just makes sense. 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 CDI and 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. These systems don’t replace your professional coders; they just aid them and ensure improved: accuracy, compliance, productivity and consistency.  How to improve clinical documentation

If you're creating a formal CDI plan, according to HIMSS, there are five key steps you need to take to improve your clinical documentation:

  • Assess documentation for ICD-10 readiness.
  • Analyze the impact on claims.
  • Implement early clinician education.
  • Establish a concurrent documentation review program.
  • Streamline clinical documentation workflow.

The time to start you CDI is NOW; your facility should avail itself to every resource possible to be ready for the October 1, 2014 deadline.

Tags: ICD-10, Clinical Documentation Improvement (CDI), Medical Coding

3 Reasons You Don’t Need To Outsource Your Revenue Cycle Management Processes

Posted on Tue, Nov 19, 2013 @ 02:25 PM

As a healthcare provider, you do not need to outsource any of your revenue cycle management activities, provided that the following are all true:

1.  All of your revenue cycle activities are completely efficient, productive and up-to-date!

2. You are totally certain that your facility will not be hit by declining revenues and negative profitability due to the transition to ICD-10.

3. You are confident that your RCM technology and processes will enable you to accommodate upcoming regulatory requirements updates, such as participation in accountable care organizations (ACOs).

However, if you are not confident of these three activities then your business is at financial risk, and you should consider working with an experienced and knowledgeable outsource partner.

In a recent survey by Black Book, a technology and services market research and opinion company, 87 percent of the medical practices surveyed, reported that their billing and collection systems were inefficient and needed upgrading. If you fall into that blessed 13 percent category where everything is just hunky-dory, you are all set to go.

If you fall into the 71 percent of physician practices – reported in the same survey -- who ARE experiencing financial hardships, you may want to consider outsourcing some or all of your RCM activities. What can you expect by outsourcing your RCM?

The largest benefit will come in the form of immediate resolution to the majority of your RCM challenges. Outsourcing your RCM can provide a wide range of services that leverage experienced people, processes and technology to provide immediate operational and financial solutions that will maximize your reimbursements and reduce expenses.  These services include: 

 Eligibility & Benefit Verification    

 In the absence of proper eligibility and benefit verification, countless downstream problems are created -- delayed payments, reworks, decreased patient satisfaction, increased errors, and nonpayment. To avoid these problems, an outside expert service can be employed to remotely host a centralized eligibility unit for medical practices. This solution can deliver an expert staff and technology management with the objective of delivering high-quality, cost-effective patient insurance eligibility and related services.    

 Medical Coding

High quality coding services are essential to the survival of a medical practice, especially with the upcoming transition to ICD-10. A team of experienced Certified Professional Coders, who are ICD-10 trained, and professionally accredited, will have the proficiency to meet any medical practices coding and billing needs.

Charge Capture and Payment Posting Services

This solution should automate the receipt, processing and posting of all RCM paper documents including charges, demographics, insurance payments, patient payments and correspondence. Services within this solution should include:

* Patient Registration

* Charge Entry 

* Payment Posting 

* Denial Posting and Management

* Account Reconciliation 

* Refund Handling

 Credit Balance Resolution    

Credit balance backlogs should be prioritized and processed. Incorrect adjustments, erroneous credits and misuse of debit codes can make the credit balance task quite challenging. A professional approach is the key to resolving credit balances, many of which become account corrections as opposed to actual refunds.

In conclusion, if everything in your practice’s revenue cycle management is “ship shape,” then you have no need for professional outsourced RCM assistance. However, if you are one of the thousands of medical practices who are struggling with daily financial hardships, you may want to consider outsourcing as a definite solution to your RCM challenges. Visit www.gebbs.com for solutions!    

 

 

Tags: Accountable Care Organizations (ACOs), Business Process Outsourcing (BPO), Revenue Cycle Management (RCM)

A Pain Tylenol Will Not Relieve!

Posted on Tue, Nov 12, 2013 @ 09:22 AM

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Inefficient revenue cycle management (RCM) and outdated RCM technologies are causing almost unbearable pain for many medical practices. These RM inefficiencies are resulting in extreme financial hardships, to the point that in a recent survey conducted by Black Book, a technology and services market research and opinion company, 87 percent of practice managers believe their revenue cycle management is so out-of-date and inefficient, it will result in the sale of the practice to a larger physician group or hospital within the next year or the practice will dissolve.

Other astounding facts the survey uncovered were:

* 72 percent of physician practices, whether in a network, independent or part of a large group or hospital system, expect declining to negative profitability next year because of underutilized or inefficient billing technologies and processes.

* 86 percent of practice business managers believe their RCM technology and processes will not be able to accommodate upcoming regulatory requirements or updates, and 100 percent believe their practice’s software is not prepared for participation in accountable care organizations (ACOs).

 * 87 percent of practices say their billing and collections systems need upgrading.

 * 71 percent of physician practices are considering a combination of new software and outsourcing services to improve their RCM systems, and 89 percent say they would prefer a single-source vendor offering software, outsourcing and consulting options.

What can be done – quickly – to resolve these challenges and bring relief to medical practices? The foregoing statistics indicate a fast solution is necessary and that is only available by enlisting immediate outside help. This help should come in the form of complete Revenue Cycle Management assistance that provides a wide range of RCM services, leveraging people, processes and technology to provide immediate operational and financial solutions that will maximize reimbursement and reduce expenses.  These services should include: 

 Eligibility & Benefit Verification    

 In the absence of proper eligibility and benefit verification, countless downstream problems are created -- delayed payments, reworks, decreased patient satisfaction, increased errors, and nonpayment. To avoid these problems, an outside expert service can be employed to remotely host a centralized eligibility unit for medical practices. This solution can deliver an expert staff and technology management with the objective of delivering high-quality, cost-effective patient insurance eligibility and related services.    

 Medical Coding

High quality coding services are essential to the survival of a medical practice, especially with the upcoming transition to ICD-10. A team is comprised of experienced Certified Professional Coders, who are ICD-10 trained, and professionally accredited will have the proficiency to meet any medical practices coding and billing needs.

Charge Capture and Payment Posting Services

This solution should automate the receipt, processing and posting of all RCM paper documents including charges, demographics, insurance payments, patient payments and correspondence. Services within this solution should include:

* Patient Registration

* Charge Entry 

* Payment Posting 

* Denial Posting and Management

* Account Reconciliation 

* Refund Handling   

 Credit Balance Resolution    

Credit balance backlogs should be prioritized and processed. Incorrect adjustments, erroneous credits and misuse of debit codes can make the credit balance task quite challenging. A professional approach is the key to resolving credit balances, many of which become account corrections as opposed to actual refunds.

If you are feeling any of the foregoing pains, put your bottle of Tylenol away and visit www.gebbs.com. We can help you survive the pains and hardships of today’s healthcare financial environment!

    

 

 

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

Posted on Tue, Nov 05, 2013 @ 11:00 AM

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.

 

Tags: ICD-10, Business Process Outsourcing (BPO), Revenue Cycle Management (RCM)

A Primer for Managing the ICD-10 Transition

Posted on Tue, Oct 29, 2013 @ 11:10 AM

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!

Tags: ICD-10, Business Process Outsourcing (BPO), Revenue Cycle Management (RCM)

A Guide for the Safari through the ICD-10 Jungle

Posted on Tue, Oct 22, 2013 @ 08:55 AM

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.

Tags: ICD-10, Business Process Outsourcing (BPO), Revenue Cycle Management (RCM)

Security Reigns Supreme at GeBBS

Posted on Tue, Oct 15, 2013 @ 10:53 AM

Implementing health information technology in a secure manner is an extremely important issue in the healthcare industry.  To remain effective and efficient, healthcare providers must utilize the latest information technology solutions.  These IT solutions require the electronic storage and transmission of sensitive patient data. They must be designed, implemented and maintained with advanced IT security measures to ensure proper risk management and compliance with governmental regulations. 

Here at GeBBS we take our security responsibilities seriously. We have become a recognized leader in the design and maintenance of optimal IT security systems. As an example of this leadership, our Chief Information Security Officer (CISO), Veerendra Sheregar, was recently selected as a 2013 finalist for the world-wide Top 100 CISO List. Veerendra was recognized for incorporating and implementing innovative information security solutions into GeBBS’ IT systems that assist the company’s customers in confidently and securely transacting business with GeBBS.

Under Veerendra’s leadership, the company’s IT solutions were singled-out for their robust and effective information security practices, which have the right balance of proactive and intelligent security processes, coupled with a strong monitoring framework, with an emphasis on data protection as a part of ISO 27001 implementation.  We thought that this recognition provided a good opportunity to talk with Veerendra about IT security and the role it plays at GeBBS.

Why do you feel that security plays such an important role in information technology delivery systems? “The elements of risk and doing business have always been inseparable, but new information security risks pose unknown challenges.  This is particularly true for healthcare information.  It must be protected with the very highest security measures. At GeBBS, information security procedures, related to the use of the Internet and e-commerce, play an extremely important role in protecting patients’ healthcare information.”

What gives you the greatest satisfaction in your role as CISO?  “I think getting the right information to the right people at the right time, securely, efficiently and effectively gives me the most job satisfaction.”

How do you feel about the recognition of making the TOP 100 CISO List?  “With all the increasing pressures on security standards to manage information policies and procedures, I’m proud to be included on the TOP 100 CISO List on the behalf of GeBBS HealthCare Solutions.”

“I would like to add that this recognition comes to me as part of my work -- the entire GeBBS team – is dedicated to providing our healthcare clients with the very best security measures, while providing them with the IT systems they need to improve their business and clinical processes.”

About the TOP 100 CISO List Award

The Top 100 CISO Awards were created by InfoSecurity Magazine partnering with iViZ Security, a cloud-based penetration testing service to recognize executives who have demonstrated outstanding initiatives in using information security practices and technology to secure their business and mission critical information in the most effective manner.

Tags: Healthcare IT Solutions / EHR

Healthcare IT Outsourcing Market Worth $50.4 Billion by 2018

Posted on Wed, Oct 09, 2013 @ 10:00 AM

A new report by MarketsandMarkets recently estimated the healthcare IT outsourcing market value will be $50.4 billion by 2018. What is driving this significant growth in the healthcare marketplace? The global market is forecast to grow at a compound annual growth rate (CAGR) of 7.6%, to reach $50.4 billion by 2018 from $35 billion in 2013. Many industry observers are suggesting that the growth is fueled by outsourcing’s ability to provide an efficient solution for mitigating rising healthcare costs and for helping to meet the growing demand for quality care.

Over the past few years, the trend of healthcare IT outsourcing solutions has grown significantly among large organizations and has also attracted mid-sized companies. In some cases, the entire information management system is outsourced, while in others, only key application services, such as implementation of electronic health records (EHR), revenue cycle management and billing functions are outsourced.

Outsourcing Advantages:

Outsourcing organizations are able to operate multiple delivery centers around the globe. They provide an in-depth understanding of the healthcare industry which enables them to provide innovative end-to-end business process outsourcing solutions to their clients. They assist their clients by leveraging this specialized industry expertise and offering comprehensive services through highly skilled professionals, and proprietary workflow engines.

Factors propelling the growth of the market are the rising pressure to curb healthcare costs across the globe and the growing need to manage cash flow in back-office administration and IT management systems of healthcare provider, payers, and life science companies. Other factors that are likely driving this rise in demand for outsourcing include: lack of in-house IT expertise, rise in the demand for integrating new solutions and growing pressures on healthcare providers to meet Meaningful Use criteria, new ICD-10 conversion guidelines for coding and the rise in an aging population.

The various markets for this report have been segmented by application and by industry. The applications market for healthcare are classified as: healthcare provider, healthcare IT outsourcing company, healthcare payer, IT outsourcing - life sciences, healthcare IT outsourcing - operational and IT outsourcing - infrastructure. The healthcare market is further segmented facilities: hospitals, diagnostic laboratories, clinics, biotechnology, pharmaceuticals, clinical research organizations, and health insurance companies.

Most Frequently Outsourced Applications:

Electronic Health Records

Revenue Cycle Management System

Laboratory Information and Management System

Pharmacy Information and Management System

Other

The health insurance industry, healthcare systems industry, and pharmaceutical industry are driving the IT outsourcing market. These industries follow the healthcare IT outsourcing model to enhance their focus on core business, reduce operational and maintenance costs, increase access to IT skilled and trained staff (further reducing hiring and training costs), share risk, and quickly implement new technologies.

North America accounts for the largest share -- 72% - of the global healthcare IT outsourcing market and is expected to reach $36 billion by 2018 from $25 billion in 2013. Asia-Pacific and the rest of the world are expected to register CAGRs of 8.1% and 7.8% (2013 to 2018) respectively, followed by North America (7.6%), and Europe (7.2%).

 

 

        

Tags: Business Process Outsourcing (BPO)