GeBBS Healthcare RCM Blog

Tips to Make Sure You Are Ready for ICD-10

Posted on Thu, Aug 20, 2015 @ 07:00 AM

 

11236638-medical-coding

October 1 is just around the corner. There is no other way to express it. Are you ready?  Training to ensure you are ready for ICD-10 is the most critical factor in preparation. You should determine your staff’s training needs based on their individual roles within your organization. Staff members will require different and specific education based on their role in the ICD-10 coding process.

First and foremost, select an experienced training partner such as GeBBS!

  • Identify which are your most frequently used ICD-9 codes. Make sure every person in your coding stream KNOWS the appropriate ICD-10 codes that correspond to your most used ICD-9 codes. This training will go a long way in helping you maintain your revenue cycle for your most used codes.
  • Conduct a high-level review of your process with a gap assessment and analyses.  A gap assessment will help you gain an understanding of where and how ICD-10 will impact your entire 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.
  • Plan for additional expenditures in time and resources as you work to prepare for ICD-10.
  • Enlist technology and an experienced outsourced partner to help with your transition.
  • Don’t try to do everything on your own. Technology is available in the form of computer-assisted coding (CAC) tools.  CAC is a proven technology that automatically derives and assigns ICD-10 medical codes from within your clinical documentation. Your organization 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 doesn't have to replace your professional coders; they just aid them and ensure improved: accuracy, compliance, productivity and consistency.
  • Enlist high quality outsourced coding and auditing support to help you get through the transition period and beyond. Highly-qualified outsourced coders, auditors, and HIM professionals can ensure you will have no disruption to your revenue cycle. These coders have undergone a stringent screening process to verify their skill level, education, experience, and level of professionalism. Most are certified RHIT, RHIA, CCS, CCS-P, CPC or CPC-H.
  • Test, Test, Test.  Begin your ICD-10 readiness testing as soon as possible and continue your testing right up to October 1. 

Tags: ICD-10, Best Practices

Uninsured Rate Dips Below 10%

Posted on Thu, Aug 13, 2015 @ 12:30 PM

By Nitin Thakor, President & CEO

I read with interest this week an article In Modern Healthcare’s e-newsletter titled, “Uninsured rate dips below 10%.” The statistic comes from The Centers for Disease Control and Prevention.

In my opinion the most important sentence in the article follows: “The survey also found that 36% of people younger than 65 were enrolled in a high-deductible health plan in the beginning of 2015.”

The growing number of people – not only the young -- who are opting into these high deductible plans is forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes. Shifting payment models, new regulations and healthcare reform are forcing healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.

GeBBS Healthcare Solutions

Most hospital CFOs and group practice managers have no choice but to look for the next generation of RCM solutions in order to keep their organizations solvent. Reimbursement challenges and coping with increased high self-pay volumes have driven many marginally performing healthcare organizations to the brink.

Other changes such as reduced reimbursements, payment reforms, accountable care organizations (ACO), ICD-10 coding transition activities, physician practice acquisitions, as well as the increased self-pay collection costs will all contribute to overall declining margins.

Not only will physicians and hospitals be swamped by treating this new wave of patients, their infusion into the healthcare system is going to create significant financial challenges due to many of the newly insured patients having extremely high deductible insurance plans, forcing hospitals and physician groups to collect this money on their own. According to a Kaiser Health News report, out-of-pocket payment amounts under the Affordable Care Act (ACA) will range from $6,350 for individuals to $12,700 for families.

This new pressure on healthcare providers’ revenue cycles is not going away; it’s something everyone will face soon.

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

Dual Coding Could Minimize ICD-10’s Impact on Revenue

Posted on Tue, Jul 28, 2015 @ 07:00 AM

 

11236638-medical-codingDual ICD-9/ICD-10 coding can generate benefits that far outweigh the negatives, if it can be done without creating productivity declines and revenue cycle slowdowns.

There is a huge cost factor to dual coding if you have to do it manually; however, there is a way to dual code without involving every coder on your staff in the process. Technology is available today in the form of computer-assisted coding (CAC) tools.  CAC is a proven technology that automatically derives and assigns ICD-10 medical codes from within your clinical documentation with a 95% accuracy rate. For GeBBS, its proprietary algorithm built in its iCode coding platform leverages deep data learning principles of both ICD-9 and ICD -10 codes.

With this kind of technology, your organization can dual code in ICD-10, while still maintaining your present ICD-9 workload.  These CAC technology solutions can work with your electronic health record (EHR) and financial systems to produce extremely accurate coding.

These systems do not replace your professional coders; they just aid them and ensure improvement: accuracy, compliance, productivity and consistency, while your facility is “getting up to speed” on the new ICD-10 codes.

CAC combines expert workflow technologies, rules-based automation, and certified coders to guarantee accuracy rates of over 95%. CAC features include:

     • Works with all input formats (including HL7, Doc, PDF and TIF, scanned paper reports)

     • Works across all medical specialties

     • 95%+ accuracy

     • 24 hours turnaround time

     • No implementation costs

Dual coding using CAC technology will allow you to:

  1. Analyze your provider documentation and identify areas of risk, offering a clear picture of which providers require additional education, and which providers could serve as physician champions
  2. Assess the quality of your ICD-10 coding, which will enable you to identify the need for, and implement needed education
  3. Provide real time data and explicit direction to the clinical documentation improvement (CDI) staff
  4. Conduct time studies enabling HIM professionals to better prepare for their specific organizational needs through analysis of real time data and actual productivity metrics, rather than planning needed ICD-10 go-live support based on  artificial data
  5. Test claims with insurance carriers, providing opportunity to identify and correct claim submission errors prior ICD-10 go-live

Some CAC technologies come with secure cloud-based auditing systems that work in conjunction with your EHR and coding platforms to provide complete medical record auditing that optimizes and accelerates your coding audit process.

Dual coding using CAC also enables financial modeling to determine how certain diagnosis-related groups (DRGs) might be weighted differently, how the new codes will affect reimbursement levels, and what edits may be required. This provides insights into the impact on net revenue or where additional or more comprehensive documentation will be required.

Tags: ICD-10, Best Practices

Healthcare Financial Professionals Seek New Ways to Rescue Revenue Cycle Management

Posted on Mon, Oct 06, 2014 @ 10:59 AM

Business pressures are forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes. Shifting payment models, new regulations and healthcare reform are forcingHealthcare Financials healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.

Most hospital CFOs and group practice managers have no choice but to look for next generation of RCM solutions in order to keep their organizations solvent. Reimbursement challenges and coping with increased self-pay volumes have driven many marginally performing healthcare organizations to the brink.

In 2014, it is predicted that changes, such as reduced reimbursements, payment reforms, accountable care organizations (ACO), ICD-10 coding transition activities, physician practice acquisitions and increased self-pay collection costs will all contribute to overall declining margins. The increase in self-pay accounts will be significant, driven the Affordable Care Act (ACA) which is going to send a huge number of newly insured patients into the healthcare delivery system. Under ACA, every U.S. citizen is required to have some form of medical insurance, or pay an opt-out fine.

Not only will physicians and hospitals be swamped by treating this new wave of patients, their infusion into the healthcare system is going to create significant financial challenges due to many of the newly insured patients having extremely high deductible insurance plans, forcing hospitals and physician groups to collect this money on their own. According to a January 2014 article in Kaiser Health News, out-of-pocket payment amounts under the ACA will range from $6,350 for individuals to $12,700 for families.

This new pressure on healthcare providers’ revenue cycles is not going away; it’s something everyone will face soon.

Tags: ICD-10, Revenue Cycle Management (RCM), Healthcare Revenue Billing, Accounts Receivable (A/R), Accountable Care Organizations (ACOs), Affordable Care Act

Healthcare Financial Professionals Seek New Ways to Rescue Revenue Cycle Management

Posted on Mon, Oct 06, 2014 @ 10:29 AM

Business pressures are forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes.Shifting payment models, new regulations and healthcare reform are forcing healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.

Most hospital CFOs and group practice managers have no choice but to look for next generation of RCM solutions in order to keep their organizations solvent. Reimbursement challenges and coping with increased self-pay volumes have driven many marginally performing healthcare organizations to the brink.

In 2014, it is predicted that changes, such as reduced reimbursements, payment reforms, accountable care organizations (ACO), ICD-10 coding transition activities, physician practice acquisitions and increased self-pay collection costs will all contribute to overall declining margins. The increase in self-pay accounts will be significant, driven the Affordable Care Act (ACA) which is going to send a huge number of newly insured patients into the healthcare delivery system. Under ACA, every U.S. citizen is required to have some form of medical insurance, or pay an opt-out fine.

Not only will physicians and hospitals be swamped by treating this new wave of patients, their infusion into the healthcare system is going to create significant financial challenges due to many of the newly insured patients having extremely high deductible insurance plans, forcing hospitals and physician groups to collect this money on their own. According to a January 2014 article in Kaiser Health News, out-of-pocket payment amounts under the ACA will range from $6,350 for individuals to $12,700 for families.

This new pressure on healthcare providers’ revenue cycles is not going away; it’s something everyone will face soon.

Tags: ICD-10, Revenue Cycle Management (RCM), Accountable Care Organizations (ACOs), Affordable Care Act, Insurance Billing 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 Importance of Physician Champions in the Transition to ICD-10

Posted on Wed, Jun 11, 2014 @ 11:20 AM

Do you have a "physician champion"? You should. A physician champion who will support your clinical documentation improvement (CDI) program and communicate the importance of an

integratedcare

ICD-10 CDI program to his or her peers will go a long way in ensuring the success of your transition to ICD-10 in October of 2015.

Providers are now keenly aware of the ICD-10 billing requirements for claims beginning October 1, 2015. There has been, and rightly so, significant concern within the healthcare industry about the financial risks that will be incurred in the transition process, including the fact that utilization of the wrong code may result in reduced reimbursement or total rejection of a claim. Some have called this change the biggest challenge to face healthcare providers since Medicare came into being in the 1960s.

Much has been written about how to prepare for ICD-10. The emphasis has been on training the medical billing staffs and coders on how to make the transition from the 13,000 ICD-9 codes to the 69,000 ICD-10 codes. Unfortunately, there hasn’t been as much time spent or resources expended on physician education and support for the upcoming conversion. Physicians need to understand how important it is for them to properly document their care in order for coders and billers to be able to fulfill their important roles in the new billing scheme.

A report in the May 10, 2014 HIT Consultant e-Newsletter stated that 44 percent of physicians were uncertain whether or not they would have been ready for the October 2014 deadline, according to the 2014 Practice Profitability Index (PPI). In fact, another 25 percent were certain they would not have been prepared to face the transition and the ICD-10 upgrade costs.

Hospitals and medical practice groups of all sizes should be focusing on physicians and their documentation of patient care as a major aspect of how to prepare for ICD-10. Experts recommend that each healthcare entity select an ICD-10 champion from within their current staff. If possible, there should be a champion from each specialty area in a multi-specialty practice or a hospital’s medical staff in order to concentrate on how to prepare for ICD-10 within that specific area of medicine. 

Champions should be trained in the codes for their specialty area and documentation requirements to support the billing codes. They need to be willing to convey to their peers thevalue of the documentation and how it relates to proper reimbursement.

Physicians respond best when other physicians are the ones educating them on how to improve their documentation.  They are not interested in codes, but are primarily interested in providing the highest level of patient care possible. Champions can convey to their peers the connection between ICD-10 codes and how more specific documentation can improve patient care. With emphasis on patient care instead of coding, physicians will be more receptive to the change.

Champions can increase motivation of providers by emphasizing the positives of the new system, including more timely and accurate payments, fewer claim denials or returns for more information and improved patient care based on the documentation. A physician champion can engage their peers into viewing the new ICD-10 codes as management tools for improving patient care, instead of simply a burdensome bureaucratic requirement for getting paid.

Having a physician champion on your ICD-10 team will make your transition efforts easier and more successful.

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

How CDI Can Improve Your Cash Flow

Posted on Wed, May 28, 2014 @ 09:01 AM

The switch to ICD-10 is delayed, but not abated. With the new implementation date of OctoberIncrease cash flow 1, 2015 will your organization be ready for the best possible transition? The best place to start is by analyzing your clinical documentation improvement (CDI) program to determine the quality of documentation. Consider using you coder and case managers to identify educational opportunities for physicians and areas for improvement. Specifically, enlist the assistance of your case managers to focus on documentation trends across the board, and work with physicians who are your largest admitters.

Documentation improvement initiatives can be conducted parallel to coder education for ICD-10 preparation. Throughout the next 12 months, conduct coder gap analyses to determine strengths and weaknesses. Coders will need deep knowledge in anatomy and physiology, medical terminology, pathophysiology, and pharmacology. Your case managers should also be included in this assessment.

Multiple new mandates, including ICD-10, RAC, Medical Necessity and pay-for-performance are making accurate clinical documentation more important than ever, and the growth in volumes resulting from the ACA are impacting all organizations. Your ability to get reimbursed is directly dependent on the quality of your clinical documentation. As you are well aware, missing, poor, or non-specific clinical documentation will result in lost revenue.

You can be prepared to mitigate this loss by engaging professional CDI specialists. These professionals are credentialed, highly-trained, and they can ensure your documentation is ready for the transition to ICD-10.  Whether you use these CDI professionals to assess your program or supplement your staff, they can help you develop, improve, and maintain your clinical documentation. They can quickly get you “up to speed” with the interim or permanent CDI professionals you need. These highly skilled and experienced CDI professionals can fit seamlessly into your current program. 

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

The Key To A Good Night's Rest...

Posted on Wed, May 21, 2014 @ 06:23 AM

Good Sleep PhotoNow that the transition date for ICD-10 has been finalized – again! Don’t let concerns about severe reductions, or even the complete stoppage of your revenue stream caused by potential ICD-10 coding errors and slowdowns in your coding productivity keep you awake at night.

There are reasons to be concerned, but proper preparations can assuage them. Early ICD-10 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.

There is hope and a good night’s rest – if you are prepared!

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.

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 staff training and education well in advance of the transition deadline.

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 extensive education and 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. In addition, make sure the educational opportunities your staff attends are led and designed by true industry subject matter experts. There are going to be many educational opportunities offered in the next six month – select the ones that will provide your organization with the most return for time expended. If you select a customized educational program, ensure it is designed to maximize content retention, while minimizing interruptions to your staffing productivity.

What’s your take on ICD-10 education and training? We would like to hear from you.

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

How ICD-10 Can Lead To An Improvement In Patient Care

Posted on Thu, May 15, 2014 @ 07:33 AM

Doctor CoverFor all the negative press ICD-10 has gotten over the past few years, it has the potential to have a tremendously positive impact on the quality of patient care. The new system will require more accurate clinical documentation, increase the amount of data collected, improve quality measurements, streamline claims processing, and ultimately improve the quality of care provided to patients.

The new implementation date of ICD-10 October 1, 2015 will be important because it will provide updated terminology and increased specificity in a variety of areas, which ICD-9 does not currently provide. Most critical is the need to replace the ICD-9 procedure classification, which is outdated, can no longer be expanded, and is unable to keep pace with advances in medicine or medical technology, as well as demands for increasingly detailed healthcare data.

In addition, the enhanced specificity of ICD-10 provides assistance with delineating clinical populations. The expanded codes more effectively capture data about signs, symptoms, risk factors, time frames, laterality (left vs. right), complications, and comorbidities. The system also differentiates body types, procedure types, surgical approaches, and devices used in treatments.

The implementation of ICD-10 offers many quality benefits. The additional granularity of data collection and detail will require improved clinical documentation and care decisions, facilitate ongoing performance improvement, enhance evaluations of population health, and enable comparisons across the continuum of care.

The transition to ICD-10 in 2015 presents a perfect opportunity to establish a clinical documentation improvement (CDI) process at your facility, if you do not have one underway already. Following are some areas on which to focus your CDI:

Laterality: A renewed emphasis on laterality within documentation under ICD-10 is intended to enhance communication between providers as they formulate each patient’s story; all of the complexities and factors affecting the care of the patient are expected to be recorded. The goal is to improve the quality of care provided to the patient.

Disease pathophysiology: Disease pathophysiology, or the study of ongoing changes in the disease state, is much more detailed in the ICD-10 disease descriptions. Documentation must reflect the highest level of known pathophysiology for diseases so that CDI specialists can identify the most accurate level of severity.

Combination codes: Combination codes have been created to merge two diagnoses that typically are related to one another. In ICD-10, this means some codes now have six options, whereas they had one or two options previously under ICD-9.

Encounter timing: ICD-10-CM requires documentation of the type of treatment that is rendered for specific conditions, such as injuries, signs and symptoms, and external causes of morbidity. Stage of care is also a critical element of this documentation.

Identification of trimester in ICD-10: For obstetrics clinicians, new definitions of trimesters have been introduced. In addition, each episode of care must be reported along with the patient’s trimester.

Increased disease specificity: ICD-10-CM has expanded many code descriptions to connect complications and manifestations with conditions.

Alcohol and drug abuse: ICD-10 has clarified the way alcohol and drug abuse and dependence should be documented to mitigate confusion when attempting to accurately represent the patient’s condition. This will include effects, aspects, and manifestations of substance abuse.

Expansion of injury codes: Documentation of the sites and types of injuries will be required in ICD-10.

Post-procedural disorders: ICD-10-CM requires documentation to indicate if a condition or disorder is caused by or follows a procedure. Every physician needs to clearly state if a procedure caused a negative impact to a patient’s condition.

Documentation practices will be the primary driver for success in ICD-10. There will be significant changes required in clinical documentation, specifically in the areas of disease specificity, anatomical site and laterality, complication and manifestations, obstetrics, and correct use of medical terminology and naming. Providers must adhere to these changes to increase the specificity of the codes as well as decrease the potential for coding errors and unpaid claims that could impact reimbursement or quality of care.

Training is the key to preparedness for ICD-10 in 2015. Training your clinicians and providers on the code specificity is the first critical step in preparing for this transition. Your education programs should be well underway to ensure that your staff members are educated on the appropriate anatomy, physiology, and level of ICD-10-CM/PCS training required for each member’s role and work setting. October 2015 will be here before you know it!

 

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

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