Browse by Topic
More than 40,000 members value HFMA's thought leadership and practical strategies. HFMA is where you need to be.
Get acquainted with the
healthcare finance industry's leading professional association. Find out why our
members rely on HFMA as their go-to source for insight and
Members have many
options for helping them advance their careers. Conferences, seminars,
eLearning, certification, and more -- our education and events will keep you
Connect the dots on today's big issues, explore collaborations, get career-boosting tips, and network with colleagues nationwide at the leading finance conference. Save $100 off the full conference rate when you register by May 8.
Real-time presentations with nationally recognized experts, networking opportunities, and industry solutions—no travel required!
Learn about timely healthcare finance topics and earn CPEs. Most live webinars are free for HFMA members and $99 for non-members. View the latest schedule.
If you're a subscriber to any of our three newsletters, you have access to online education. Learn more or subscribe.
Get the perspectives of leading healthcare finance professionals on today's hottest issues.
Information about leading vendors helps your buying decisions.
Forum members can network during live webinars or access a library of past webinars on topics such as bundled payment, charity care, and ICD-10.
An ever-expanding collection of spreadsheets, policies, job
descriptions, checklists, and more that you can adopt and adapt.
Forum members can submit vexing questions to a panel of experts
using our Ask the Expert service.
Your source for employment solutions.
Find new employment opportunities or
reach out to qualified candidates.
Distinguish yourself as a
leader among your peers and advance your career by earning certification in our
healthcare finance programs.
Get an objective third-party evaluation of products and services used in the healthcare finance workplace.
MAP App is a web-based application that helps organizations improve revenue cycle performance based on industry-standard metrics called MAP Keys.
Find suppliers and products in this comprehensive vendor directory for healthcare finance professionals.
Guidance for understanding and communicating about the price of health care.
Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
By Kathleen B. Vega
“We knew this effort would be complex and time-consuming, and we decided to start early so we could effectively prepare for the ICD-10 transition,” says Cynthia D. Fry, PhD, vice president revenue for CHE. “We also wanted to leverage our system’s size and identify any ‘one and done’ components that we could implement systemwide to gain efficiencies and streamline work. Not everything can be done at the system level, but items such as a project plan, financial impact analysis, assessing payer readiness and software vendor preparation do lend themselves to a global approach.”
This is a sample article from HFMA's Revenue Cycle Strategist newsletter, a print newsletter that helps hospitals and health systems achieve peak revenue cycle performance.
Learn more—and subscribe—to Revenue Cycle Strategist.
Taking the First Steps
To begin, CHE developed a business plan. “We started information gathering early on—reading about ICD-10, attending webinars, and talking with colleagues in other organizations,” says Howard Walker, ICD-10 program manager for CHE. “All the research was used to form an initial business plan, which included a concise description of the core changes that would result from the new coding system.”
Once the plan was created, Fry and Walker met with senior leadership to educate them on the plan and garner support.
“We brought in an outside speaker who was a former senior leader in a multihospital system and an acknowledged expert in ICD-10,” says Fry. “She talked about the potential impacts of the new coding system and spelled out the risks to our organization if we did not have a well-defined, comprehensive approach to implementation.”
After the speaker laid the groundwork, Fry and Walker presented the initial business plan and obtained leadership support as well as a budget for the work. "I believe this approach of having a peer introduce the topic of ICD-10 was beneficial, because she was able to effectively pave the way for our presentation," comments Fry.
In conjunction with developing the business plan and meeting with senior leadership, CHE also created a core team at the system level to guide the ICD-10 work. Made up of representatives from the revenue cycle, IT, health information management, and nursing, this team meets bi-weekly to talk about ICD-10 implementation and other related topics.
“We have found there is always something to discuss,” says Fry. “Our various hospitals also have ICD-10 teams, but the system-level team covers many of the issues that will impact the entire organization. For example, we searched and selected an ICD-10 Web-based training tool designed to accommodate the various stakeholders from coders to physicians. As a system, we leveraged our size to get preferred pricing and purchased unlimited licenses. Every stakeholder group at all our hospitals is now assured to receive the same training, and we can track who is attending and who is not.”
Creating Five Goals for Implementation
As CHE was laying the groundwork for implementation, the following five goals for the work emerged as part of the business plan:
“We basically segmented the implementation process into five distinct buckets,” comments Walker. “These efforts not only drive the ICD-10 work, but are also significant initiatives on their own with dedicated committees, budgets, project plans, and processes. At the system level, we are planning for and working toward all of these goals to ensure an effective ICD-10 transition.”
Goal 1: Eliminating erosions in coderproductivity. CHE is turning to technology to help address this goal. “We are implementing a computer-assisted coding tool across the system,” says Walker. “We want to get this tool in place well before the switch to ICD-10 so we can get past the learning curve before the code sets change.”
To further enhance productivity, CHE also partnered with a local community college to provide online training to coders systemwide in anatomy and physiology. “Because the level of detail is much greater in ICD-10, we wanted to supplement coder knowledge and be sure all received the same level of training,” comments Fry. CHE is also evaluating its coder backfill strategy and coder retention plan.
Goal 2: Avoiding any unfavorable financial impacts through the analysis of current coding and documentation patterns. “We found a tool to help us expedite data analysis at an ICD-10 conference,” says Fry. “An accounting firm developed a software tool that analyzes the impact of ICD-10 based on current claims data. This tool answers the question, ‘What would the financial impact be at the DRG level if we flipped a switch to ICD-10 today?’ We have completed a first pass on the data for all our hospitals and are now drilling down to the specific issues identified at each hospital.”
CHE is also assessing payer readiness and whether the payers will be processing claims in ICD-10 or mapping back to ICD-9. Expecting an increase in claim denials and payment variances, CHE is developing a resource plan to support central billing offices (CBOs).
Goal 3: Minimizing disruptions in patient throughput in the outpatient setting. The switch to ICD-10 will not affect every department in an organization in the same way. For example, what happens if an inordinate amount of patients present themselves on Oct. 1, 2014, with an order for a test that does not have an ICD-10 code or the written diagnosis is not specific enough? How will medical necessity be checked? Outpatient areas that currently use ICD-9 codes will need specific attention in updating their processes for ICD-10. To identify departments that need attention, CHE created a 31-question online survey to assess department needs.
“We piloted the survey with one facility to see if the questions were relevant and generated meaningful answers,” says Fry. “Once we determined we could glean the necessary information using the survey, we are starting to implement hospital by hospital. We identify high-risk outpatient departments and then go on site to conduct a review and develop recommendations.” (See the workflow analysis survey questions.)
Even without the survey, CHE knows that certain departments will need more attention than others. To understand the scope of ICD-10 impact in these areas, CHE is developing a picture of current state process flow that identifies the flow of paper, use of systems, and where current ICD-9 and future ICD-10 codes are and will be used. The organization is then performing a gap analysis, evaluating risk along the process flow to further pinpoint areas that will need focused attention. Two exhibits illustrate this effort for one of CHE's emergency departments. The Emergency Department Patient Flow diagram shows a current state process flow for the department at one hospital.
In addition an ED-specific ICD-10 Analysis shows how CHE assigns risk to the different components of the process flow.
Access related tool: ICD-Impact on ED Patient Flow
Goal 4: Ensuring that physician documentation is ICD-10 compliant. “Prior to starting work on ICD-10, we did not have a systemwide clinical documentation program,” says Fry. “We developed a business plan, created a steering committee, and have implemented a clinical documentation program across the organization. The clinical documentation improvement (CDI) specialists are completing our ICD-10 Web-based training now and will start coaching physicians on some of the basics of ICD-10 documentation such as specificity, underlying cause, and documentation of associated relationships. Physicians will learn proper documentation without knowing it is ICD-10 documentation that they are learning.”
Goal 5: Implementing information systems to support the work. Progress toward meeting this goal can be seen in the work involved with all the other goals. Specifically, the implementation of a computer-assisted coding tool will help realize a smooth ICD-10 transition. CHE is also working to develop structured templates in the electronic health record that support the documentation requirements for ICD-10.
Looking Externally for Support
As CHE pursues its ICD-10 goals, it is also leveraging relationships with external partners. “We maintain strong relationships with all our vendor partners, and they have been very helpful as we work to get ready for implementation,” comments Walker. “They have provided resources, education, and creative thinking to help us identify solutions that address the unique needs and characteristics of our system.”
CHE is also sharing information with other hospitals and health systems. “Most of the time you don’t collaborate with your competitors, but ICD-10 is one thing we can work on together,” says Walker. “We have regular conference calls with several hospitals in our geographic area in which we discuss our work toward implementation, problems we are having, information we have learned, and so on. We talk about payer issues, vendor readiness, and training needs and resources. We have even brought in speakers to talk with the group on specific topics.”
The Effects of the Delay
CHE started focusing on ICD-10 early and experienced tremendous momentum toward implementation. The recently announced delay in the ICD-10 deadline to Oct. 1, 2014, has slowed organizationwide progress but not halted it.
“Although we were frustrated by the delay at first, because we were afraid the ICD-10 work would become a lesser organizationwide priority, we are now seeing a benefit to the delay,” says Walker. “Some of our technology that will support the transition, such as the computer-assisted coding tool, has taken longer to move forward than we originally anticipated, so it's nice to have the extra time. As it is now, we can continue to work toward achieving our implementation goals and make sure we are truly ready when the new deadline arrives.”
Kathleen B. Vega is a freelance healthcare writer and editor, La Grange, Ill. (firstname.lastname@example.org).
Interviewed for this article were Cynthia D. Fry, PhD, vice president revenue for Catholic Health East, Newtown Square, Pa., and a member of HFMA’s Metropolitan Philadelphia Chapter (email@example.com); and Howard Walker, ICD-10 project manager for Catholic Health East, Newtown Square, Pa. (firstname.lastname@example.org).
Catholic Health East is a not-for-profit health system headquartered in Newtown Square, Pa., with facilities in 11 eastern states. The health system comprises 35 acute care hospitals, four long-term acute care hospitals, 26 freestanding and hospital-based long-term care facilities, 12 assisted-living facilities, four continuing care retirement communities, eight behavioral health and rehabilitation facilities, 31 home health/hospice agencies, and numerous ambulatory and community-based health services. Catholic Health East facilities employ more than 60,000 FTEs.
The health system is the largest not-for-profit provider of home healthcare services—ranked by number of visits—in the nation, as well as the nation’s leading provider of Program of All Inclusive Care for the Elderly (PACE), based on the number of programs.
Publication Date: Monday, October 01, 2012
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
HFMA's print, email, online, and mobile opportunities provide you maximum reach and impact. We will work with you to build a plan that meets your needs. Contact a sales rep.
HFMA offers online, email, and print opportunities to help you recruit the most talented healthcare finance professionals. Place your classified ads today.
Drive down costs while improving quality in a reform environment.
Stay informed about new directions in healthcare finance. Share tools and strategies for improving performance. Be an active participant in your profession. Together, we’ll reshape the business and practice of healthcare. Join us.
©2015 Copyright Healthcare Financial Management Association
HFMA.org is best viewed using IE9 or the latest versions of Chrome, Firefox, and Safari.
Join HFMA today and enjoy: