GeBBS Healthcare Blog

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.

How much emergency cash should you have in reserve to deal with ICD-10? Most healthcare providers can expect disruptions, some of them very serious, in their payments during the transition to ICD-10. Even if you have made preparations for this event, it is likely your revenue stream will take some kind of hit.

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.

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.

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.

• Customer satisfaction -- The most important factor to consider in a BPO engagement is, are you satisfied with your results. If you aren’t satisfied with the engagement, then no matter how many objectives were met, it is not considered successful.     
• Financial savings -- BPO in many cases provides a financially compelling alternative to providing the services in-house. Most engagements identify this as a key objective. If the BPO services are not improving your bottom line, they are not successful.
• Service delivery and quality – Service delivery and quality aren't usually used in the same sentence, but they should be. Your objectives for the BPO engagement should be as specific as possible when documenting your expectations on delivery and quality. To make this a truly deliberate requirement, add a metric that tracks the number of requests you have to make for a specific service to be addressed and then document how your request was handled. This adds the quality aspect to delivery.
• Scalability to meet your needs -- Your BPO partner needs to be positioned to meet your growth requirements. An important measure of their success was how quickly they were able to ramp up their staff and skill sets to meet your changing needs.
• Stability and variability – Your BPO provider needs to provide a stable operational environment even in situations that are variable. Some of the most successful BPO ventures are with components of IT or applications that are sometimes very stable, but often provide variability that must be dealt with “on the fly.” Was your BPO vendor able to handle these situations?
• Predictability – You should expect predictability in your BPO services. Establish metrics around what you define to be “predictable” and measure your BPO provider against them.
• Competency and staffing -- Competency and staffing are strategic BPO business issues. Did your BPO partner provide competent staffing and the appropriate skill sets to meet your specific needs?
• Ability to react to changing requirements -- BPO is sometimes associated with an increase in formality, which manifests itself in the form of “red tape.” When your business requirements changed, was your BPO partner able to respond to these changes in a timely manner?

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.
 

Today’s healthcare delivery system is at the center of many political and social debates. The ongoing focus of these debates is often how the healthcare financial process is handled, and it is one of the many problems frustrating professionals in the billing department of hospitals and medical facilities.

The state of our economy is on everyone’s mind today. Our business leaders understand that job creation and company growth is an increasingly global proposition, especially with the growth of outsourcing over the past two decades. Outsourcing began small, focused on finding cheaper manpower for labor-intensive jobs such as telemarketing and data entry at the beginning of the millennium. However, the paradigm is changing. Leading business organizations, including those in the healthcare industry, are outsourcing even their “core competencies” to gain a competitive edge with Knowledge Business Process Outsourcing.