GeBBS Healthcare RCM Blog

The Importance of Revenue Cycle Management in an Evolving Healthcare Delivery Environment

Posted on Tue, Dec 06, 2016 @ 06:00 AM

At the recent Becker's Hospital Review 5th Annual CEO + CFO Roundtable healthcare experts seasoned in the revenue cycle management (RCM) process discussed how their organizations and companies are working to stay ahead of the financial curve.  As hospitals evolve into a value-based care delivery environment, RCM becomes even more critical.

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The Roundtable highlighted the fact that hospitals are striving to cut costs and that has paved the way for revenue cycle management to come center stage, with organizations throughout the nation making it a top priority. Each year, the United States spends $2.7 trillion on healthcare. Of that figure, $400 billion goes toward claims processing, payments, RCM management and bad debt, a 2009 McKinley & Co. study found. Additionally, the study also found 15 cents of every U.S. healthcare dollar goes toward revenue cycle efficiencies.

As patients become increasingly responsible for their healthcare dollars and margins get tighter due to shrinking reimbursements, the need for an end-to-end RCM process reaches a critical tipping point.

An end-to-end revenue cycle management process must be comprehensive and include everything from payor credentialing to complete billing and collections services. One of the Roundtable participants, a large healthcare system, had tried using an outside software solution, but allowed each member hospital to apply the solution in its own manner. They achieved only mixed results.

An experienced outsource provider of RCM solutions will have the management expertise in all facets of the revenue cycle and knowledgeable people to provide and manage an all-inclusive solution. Their billing experts will be well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. They will also have the expertise to follow industry-standard key performance metrics and integrate best practices, so you will achieve the RCM results you desire.

An effective, end-to-end RCM outsourced solution will also include an HIM management component. This will provide an in-depth innovative solution that will allow you to successfully resolve your RCM challenges, while enhancing your overall business operations. A well-qualified outsource company will form a partnership with your hospital to optimize your RCM processes by leveraging their people, processes and technology to ensure your success.

Tags: Health Information Management (HIM), Revenue Cycle Management (RCM), Offshore Revenue Cycle Management, RCM Solutions, Revenue Cycle Solutions

10 Steps for ICD-10 Readiness You Must Know

Posted on Tue, Jul 08, 2014 @ 09:48 AM

There have been numerous delays to the implementation of ICD-10. These delays have causeddescribe the image untold frustration, -- but they have also created opportunities for healthcare providers and the organization that serve the healthcare industry. You now have time to readjust your ICD-10 timeline preparations. As an HIM Director for many years, I am offering a plan of action that may help you be prepared for the October 2015 deadline.

Considerations for Your ICD-10 Preparation Timeline

First, don’t stop or delay your planning and preparations. You have probably already accomplished some of the tasks required to meet the transition to ICD-10.  Stay the course; keep on preparing and simply be ready early – in 2015.  

Here’s a brief outline of my plan. If you would like the complete details of this my plan, please click on the button at the end of this blog. There are a myriad of steps under each of the following major headings that you need to take to be prepared.

Outline for ICD-10 Preparations

  1. Organize YOUR ICD-10 Efforts
  2. Assess the Impact ICD-10 Will Have on Your Organization
  3. Conduct Vendor Assessments for the Support You Will Needs
  4. Contact Billing Services and Clearinghouses to Assess their Preparedness
  5. Assess Your Training Requirements
  6. Revise Internal Processes as Necessary
  7. Identify Your External Testing Needs and Dates
  8. Conduct a Risk Assessment for Areas that May Present Challenges
  9. Implement ICD-10 Coding in Your Workflow
  10. Monitor Your Accuracy – Audit, Audit, Audit

A good preparation plan will significantly reduce your risks. Any transition of this magnitude will present a huge risk to your organization. Misapplication of the new coding not only threatens lost income but an assortment of other administrative and even legal issues.  Use this new delay in the compliance date to reassess your plan and ensure that everyone in your organization is prepared.

Adopt new technologies where needed. Obsolescent technology is a burden for any healthcare organizations, and will even be more critical during the transitions to ICD-10 Technology has a short lifespan and new technologies, such as computer-assisted coding (CAC) are being perfected every day. There are also staff support services that can augment your staff’s expertise during this transition. Avail yourself to every possible avenue of assistance during the transition, and most importantly – BE PREPARED!

For my complete plan click here.

 

Let's Talk About ICD-10

 

- Stacy Swartz, RHIA, CCS, CPC 

Tags: ICD-10, Health Information Management (HIM)

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

Posted on Wed, Oct 02, 2013 @ 10:53 AM

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!

 

Tags: ICD-10, Health Information Management (HIM)

How Much Cash is Enough?

Posted on Tue, Sep 10, 2013 @ 08:02 AM

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.

Since all your expenses and cash outlays will remain the same, and may even increase, during the transition, some industry pundits are suggesting that you have several months of cash reserves, or at least, access to cash through loans or lines of credit to avoid potential problems.

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. How many healthcare providers have this kind of cash on hand? Not many.

You can count on delays in your reimbursements, and having access to cash reserves may not be a bad idea, but this is not an option for all providers. One option that is available to everyone is – preparation! You can be prepared to mitigate the financial risks of the transition to ICD-10. Even with lots of testing by vendors, clearinghouses and payers, no one can actually know the true effects of ICD-10 until they “flip the switch” on October 1, 2014.

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 have a “steep hill to climb” to be ready to meet the ICD-10 deadline.

You can be prepared to mitigate your revenue stream disruption

The time to start your risk mitigation activities is NOW! And, your first step should be to conduct an ICD-10 readiness review. This review will provide a roadmap that can guide your organization through a successful transition experience. As mentioned earlier, no one can know the actual effects of the transition, but you can examine carefully where and how the new coding set will affect your entire organization.

To deal with this change management, 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.

Readiness review 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 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 proactively make critical process changes before the deadline falls and your revenue is impacted.

Educational opportunities are available

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 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

Don’t try to everything on your own

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.  These tools automatically derive and assign medical codes from within clinical documentation. Many are already ICD-10-ready.

Your organizations can streamline your revenue cycle processes with CAC tools, 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.

Implement revised processes discovered during gap assessment

The final steps in your journey to ICD-10 compliance require the implementation of your revised business processes, uncovered during your gap assessments. This is easier said than done, but it has to be accomplished. Another option is to enlist outside coding help for a period of time to ensure your coders have the expertise and bandwidth 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.  You can count on delays in your reimbursements, during the transition process, but with a good plan of action in place, you can mitigate a significant amount of your financial risks. If you are properly prepared, there is a good chance you won’t need six months of cash in reserves when they “flip the switch” on October 1, 2014.  Anyway, who has that kind of cash in reserve?

 

Tags: ICD-10, Health Information Management (HIM)

How To Reduce Costs & Improve Quality | Revenue Cycle Management

Posted on Wed, Dec 05, 2012 @ 07:53 AM


According to a recent healthcare technology research study, U.S. Revenue Cycle Management by HIMSS, focused on the revenue cycle management (RCM) marketplace, positive changes are predicted in the attitudes of CEOs, CFOs and IT directors toward the efficacy of RCM to improve a healthcare facility’s financial operation.

The study included nearly 400 participants -- CEOs, CFOs and IT directors -- representing 360 U.S. hospital organizations of various sizes with the objective of assessing how the HITECH Act’s focus on stimulating the adoption of Electronic Health Records (EHR) and Health Information Exchange (HIE) solutions combined with the delay in the ICD-10 compliance deadline was impacting the RCM marketplace.

The study found that 21 % of participants said they were planning to replace or enhance core RCM capabilities in the next 24 months, and for hospitals with more than 400 beds, that number increased to 36 %. 53 % of the respondents said they plan to upgrade their core RCM due to healthcare financial regulatory changes, with that number increasing to 68 % for the hospitals with more than 400 beds.


“With claims processing
errors alone costing
$17 billion per year and
rising, RCM is
an integral part of any
HCIT system intended
to reduce costs and
improve quality.”
Source: Duff & Fhelps

 

The study clearly showed an active RCM market over the next 24 months, as more than 20 % of U.S. hospitals will be replacing their core RCM solution while another half will be investing in upgrades to their current core RCM solution. The study’s results indicated that clinical systems like EHRs had pushed aside the focus on many things, including updating the RCM process over the last three or four years. The study further showed that healthcare administrators are now re-focusing their goals on investing and prioritizing the improvement of their revenue cycle management.

The study also predicted that the active marketplace trend in replacing systems and investing in upgrades when it comes to RCM systems is expected to continue for the next two or three years. There are definite signs that hospitals are beginning to have a stronger opinion about the importance of revenue cycle management and its impact on their successful operation.


RCM offers healthcare providers a solution
to increase revenue capture, often with

minimal upfront implementation costs.

outsourcing GeBBS


Other key findings from the research included:

  • Eligibility verification, POS collections and medical necessity checking round out the top three front office bolt-on solutions for planned investment.

  • Kiosks are a strategic priority for institutions with 400 or more beds.

  • Coding, denial management and contract management round out the top three back office bolt-on solutions for planned investment.

  • 42 %  of participants indicated the driver for bolt-on investment was improvement of collections (front and back office).

  • Confidence levels concerning the efficacy of RCM and the need for ICD-10 migration assistance were relatively high, scoring eight on a ten point scale.

  • Denial management remains a challenge for institutions, regardless of size.

In conclusion, the study also found that increasingly (58 % this year compared to 40 % in 2010) healthcare organizations favored utilizing a single vendor to handle all their RCM work.

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Tags: ICD-10, Health Information Management (HIM), Revenue Cycle Management (RCM), GeBBS Healthcare Solutions