Get the E-newsletter
Four industry experts share their thoughts about the upsides and downsides of ICD-10.
On the pro side of the value equation, the transition to ICD-10 will bolster performance improvement efforts, say industry experts. The increased specificity and thoroughness of ICD-10 coding will deepen the understanding of diseases and help to identify the most effective approaches to treatment and disease management. Providers and payers also expect to see a reduction in the volume of rejected and fraudulent claims and an increase in the accuracy of payments for new procedures. But this transition is a costly one—both in terms of dollars and staff time.
How will the shift to ICD-10 coding improve quality improvement efforts?
Strumwasser: Because ICD-9 coding was less specific, our quality improvement projects at Swedish Medical Center were laborious. Because the diagnostic codes were relatively non-specific, it was difficult to accurately compare the care of patients who had similar disease processes. With ICD-10, comparisons will be more specific, and quality improvement initiatives will be more fruitful.
ICD-10 should make quality improvement efforts easier because we will be gathering more accurate and more actionable data. When we have greater specificity of coding, it will allow us to capture more data so we can make sure we are comparing apples to apples. For example, the new coding system expands clinical classifications so coders can distinguish between persistent or intermittent forms of disease instead of placing all patients in the same disease category. Our quality improvement team can then begin to assess the effects of disease management and patient noncompliance on outcomes.
Bowman: With the ICD-9 codes, providers could only identify patients in rather large buckets because that was the level of specificity they had. For example, records of patients who had a mishap in a hospital or who had certain types of surgeries received the same code regardless of the circumstances surrounding the adverse event or the degree of difficulty of the surgical procedure.
With ICD-10 codes, providers get far more refined information so they can do more detailed levels of analysis. The ICD-10 coding system allows providers to learn whether a patient fell in the bathroom or in the corridor or in the hospital cafeteria. The expanded number of codes for surgical approaches and anatomical locations allows providers to link patient outcomes with the way a surgical procedure was performed.
What major steps have been taken so far to gear up for ICD-10?
Strumwasser: We have had a clinical documentation integrity program for three or four years. Even before we started on ICD-10 work, our clinical documentation specialists worked closely with physicians to make sure we captured all the comorbidities and acuity we needed to. We have people in the organization who are now training coders in ICD-10, and we are allocating FTEs to educate the physicians’ offices on the ICD-10 coding requirements. We’ve met with groups of our affiliated physicians to teach them what ICD-10 will mean for their specialties. In orthopedics, for instance, we are focusing on the nuances, such as the cause of a condition, the type of encounter with the patient, and the place where an injury occurred, that now need to be incorporated in the patient narrative. We also are incorporating automated “smart tools,” such as templates and handheld applications, to make documentation easier for our physicians.
Mihalik: I don’t know that everyone has recognized the breadth and scope of this change and its downstream effects. At Cleveland Clinic, many of our clinical specialties have their own unique outcome and quality measures in quality registries. We have had to make sure we are prepared to report to those quality registries after ICD-10 implementation by providing the appropriate mapping that will accurately reflect the specificity of care provided, leveraged by the additional opportunities that ICD-10 provides.
Watson: Aetna has been on the journey toward ICD-10 since the end of 2009 so most of our remediation work has been completed, and much of what we have currently underway relates to testing. We are working and testing with a targeted group of providers that share vested interests with Aetna because of their contracting methodology and because of their high level of interest in how the ICD transformation proceeds. We are impressed with our partners; they are right on track.
For the testing that has been planned for 2014, we have an agreement with all of our partners that there will be no change; we will proceed to the end of that plan. Our goal is to take the output of that effort and share our results in general terms as broadly as we can with providers at industry conferences.
Bowman: The provider organizations have been reviewing samples of their records to see if clinical documentation supports the specificity in ICD-10 codes. If it doesn’t, they have begun educating doctors about the clinical documentation that is needed to support the more detailed ICD-10 codes.
Providers have also been doing impact assessments to examine every policy and system touched by ICD-10 codes, including utilization management and patient scheduling/registration, which use codes to identify medical necessity criteria. Providers have been converting systems, and training coders and other staff.
How have plans changed since the announcement of the delay in ICD-10 implementation?
Strumwasser: We are trying to operationalize as much as we can in advance of the ICD-10 rollout to make the organization ready. So we are ignoring the delay and proceeding with the same timeline as before. Swedish is now part of the Providence Health System. As a member of that 34-hospital system, we are beginning the process of incorporating ICD-10 in our coding as a sort of beta case in order to be fully prepared once we are asked to do ICD-10 coding routinely. The Providence health system is planning to be ready for end-to-end testing of 837 claims and 835 remittances with its clearinghouse trading partner in the next few months.
Mihalik: We were on a path toward suc--cess and felt that we were well prepared to manage the change to ICD-10 this year. The challenge with the new compliance date is to balance ICD-10 work with other technology initiatives. We wanted to complete the transition to ICD-10 so we could focus on other projects; now we need to shift all our priorities.
The process we are going through right now is to resize our ICD-10 efforts and time them appropriately so we will be well prepared when the new compliance date arrives. We are making sure all our work streams are active until we get an organizational perspective on where we are, what we need to finish, and what we can put away and bring out another day. We need to take time to figure out the cost/benefit relationship for all our health information management initiatives to make sure we continue to leverage the skill sets we have built already and use them in the most efficient way.
Watson: We are doing what many entities have been doing. We are taking stock of our program, looking at how business is being affected by the change. We’re looking at what makes sense to continue doing and what may need to ramp down and ramp back up when we get to this time next year. We don’t have crystal clarity on how the delay is impacting our program, but we are going through the exercise of looking across all activities and reforecasting a plan now that we know we will have a new implementation date.
What specific concerns are arising because of the delay in implementation?
Bowman: Many providers have started dual coding so they could compare their case mix and service lines and see how reimbursement would change with ICD-10. But that is expensive, and providers don’t know if they can keep that up for 1 ½ years due to the cost.
There is also the whole issue of retraining. A large number of providers have done most or all of their training. An issue related to the move to a 2015 ICD-10 compliance date is how to ensure that coders maintain coding skills. If coders are not using ICD-10 data, they will not be able to keep their skills up to date and they will have to be retrained or sent back for refresher courses. An unfortunate ramification of a delay this close to the go-live date is the effect on graduating HIM students who have learned only ICD-10 and whose employment prospects are thus jeopardized by the delay.
Mihalik: Cleveland Clinic has a detailed education plan that focused on our most significant needs from the ICD-10 perspective, and we were ready to roll out that education plan for our physicians this spring. But it just doesn’t make good sense to invest our clinicians’ time in learning about ICD-10 language when they won’t use it for a year. So we will wait and do that specific work later in the ICD-10 planning process.
Watson: Aetna has many surveys and questionnaires submitted to us from providers, and we have seen an uptick recently in the number of questions about our own readiness. We want to reassure providers that we have performed significant testing internally and externally and addressed any issues that were identified. We hope that providers stay the course so they will be ready for the 2015 compliance date. We worry that won’t happen and that providers will not use this time wisely to work with vendors on their software needs, make sure their connections with clearinghouses work, analyze the effect of ICD-10, and streamline systems to remove the impediments that interfere with their own readiness for ICD-10.
What are some strategies for keeping costs down?
Bowman: Thorough planning and preparation are key. Don’t let the delay impact your momentum. It’s important to “stay the course” in order to avoid having to scramble to get ready for the compliance date. Focusing on clinical documentation excellence helps to reduce costs down the road by leading to improved coding accuracy and productivity, reduced physician queries, and reduced claims denials. Use of computer-assisted coding technology can also decrease costs down the road by improving coding productivity.
Mihalik: All the different aspects of preparing for ICD-10 are important and they all depend on one another. The physician education, coding, IT readiness—they all fit together, and the work stream for ICD-10 affects the other work the organization has underway. We have to look work stream by work stream to find the right cost/benefit balance for each area.
Bowman: Providers have not reduced expenses in one area, and that is coder training. Providers have given coders the full amount of training, because they realize careful coding will affect costs down the road. But one approach to help decrease initial training costs is to have one coder become an ICD-10 trainer for the rest of the coding staff. This avoids incurring the cost of travel for sending all the coders out for training.
Mihalik: Coding is an area in which we have already made significant investment. Nearly all our coders and clinical documentation staff are trained on ICD-10. That’s not an investment we will walk away from and pick up later. But we need to be creative in how we maintain the coding skill set while ICD-10 is not in compliance mode. Our plan is to do some focused dual coding skill labs and workshops to keep folks fresh with their ICD-10 skills. The coders who have been trained only in ICD-10 need to get trained in ICD-9 for the short-term and then be ready to go on ICD-10 when the compliance date arrives.
We believe cost savings will come from our focus on clinical documentation, which will ultimately reduce denials and any rework questions that may come up. Our focus on training and education will minimize the negative impact on productivity in the initial stages of ICD-10 compliance. By building our own internal staffing expertise on coding and clinical documentation, we will be able to reduce our reliance on external vendors, and that also will be a saving for us.
Change Healthcare: Accelerating Revenue Cycle Transformation
Jason Williams, vice president for strategy and business analytics, Change Healthcare, discusses the importance of technology and technology-enabled services in reinventing the revenue cycle.
Ensemble Health Partners: Driving Revenue Cycle Innovation
Judson Ivy, president of Ensemble Health Partners, discusses the value of revenue cycle outsourcing and the importance of selecting the right partner.
Grant Thornton: Facilitating EAM
Priority Advantage: Helping Organizations Optimize Their Medicare Advantage Plans
6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
10 Ways to Reduce Patient Statement Volume (and Reduce Costs)
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Reduce Patient Balances Sent to Collection Agencies: Approaching New Problems with New Approaches
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
The Future of Online Patient Billing Portals
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Payment Portals Can Improve Self-Pay Collections and Support Meaningful Use
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Clarity Drives Collections
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
Revenue Cycle Payment Clarity
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Streamlining the Patient Billing Process
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Wallace Thomson Hospital Automates to Maximize Limited Resources
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
7 Steps for Building and Funding Sustainability Projects
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Key Capital Considerations for Mergers and Acquisitions
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
Key Capital Considerations for Mergers and Acquisitions
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Trend Watch: Providers adapt as value-based care moves from hype to reality
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center case study
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Reforming with a New 50-Bed Acute Care Facility
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
Providers Focus Too Much On Revenue Cycle Management
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
Lucille Packard Children’s Hospital Stanford Case Study
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
ZOLL and Emergency Mobile Health Care Case Study
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Maximizing Medicare Reimbursements White Paper
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Denials Deconstructed: Getting Your Claims Paid
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
Building a Clinically-Integrated Network
As value-based payment models evolve, providers are challenged to maintain superior clinical outcomes while controlling costs.
Winning in the Post-Acute Marketplace
Read more about factors contributing to the changes in the post-acute marketplace and what it means for manufacturers, physicians, clinicians, patients, and post-acute facilities as they anticipate the transition to the second curve.
Building A Common Vision with Employed Physicians
HSG helped the physicians and executives of St. Claire Regional in Morehead, Kentucky, define their shared vision for how the group would evolve over the next decade. As well as, develop the strategic and operational priorities which refocused and accelerated the group’s evolution.
Practice Performance Improvement
The client was a nine-hospital health system with 14 clinics serving communities in a multi-state market with very limited access to care, poor economic conditions, high unemployment, and a heavy Medicare/Medicaid/uninsured payer mix. In most of these communities, the system was the sole source of care.
Though the clinics were of substantial size (they employed 98 physicians) and comprised of multiple specialists, the physicians functioned as individuals and the practices lacked any real group culture.
Clinical Integration Without Spending a Fortune
Clinical integration can be expensive, but it doesn’t have to be, as this four-step road map for developing a CIN proves. Does it have to cost millions to initiate a clinical integration strategy?
Contrary to popular belief, we have clients who have generated substantial shared savings and a significant ROI over time, without massive investments. Yes, some financial capital is required for resources the CIN providers can’t bring to the table themselves. But the size of that investment can be miniscule relative to the value it produces: improved outcomes and documentation for payers.
Adding Value to Physician Compensation
Today’s concerns about physician compensation are the result of the changing healthcare environment. The transition to value is slow, but finally becoming a reality. Proactive hospitals want to ensure that provider incentives are properly aligned with ever-increasing value-based demands.
This report focuses on the three big questions HSG receives about adding value to physician compensation; Why are organizations redesigning their provider compensation plans? What elements and parameters must be part of successful compensation plans? How are organizations implementing compensation changes?
Effective Revenue Cycle Management in Your Network
Revenue Cycle Management has become an even more complex issue with declining reimbursements, implementation of Electronic Health Records, evolving local carrier determinations (LCD), and payer credentialing [The emphasis on healthcare fraud, abuse and compliance has increased the importance of accuracy of data reporting and claims filing).
The efficiency of a medical practice’s billing operations has critical impact on the financial performance. In many cases, patient billings are the primary revenue source that pays staff salaries, provider compensation and overhead operating cost. Inefficiencies or inaccurate billing will contribute to operating losses.
Succeeding in Value-Based Care
This publication identifies and outlines the necessary characteristics of a fully-functioning clinically integrated network (CIN). What it doesn’t do is detail how hospitals and providers can participate in the value-based care environment during the development process.
One common misconception is that the CIN can’t do anything significant until it has obtained the FTC’s “clinically integrated” stamp of approval. While the network must satisfy the FTC’s definition of clinical integration before single signature contracting for FFS rates and contracts can legally start, hospitals and providers can enjoy three key benefits during the development process.
Therapy: Benefits at All Levels of Care
Nearly half of all Medicare beneficiaries treated in the hospital will need post-acute care services after discharge. For these patients, a stay in an inpatient rehabilitation facility, skilled nursing facility or other post-acute care setting comes between hospital and home.
Does Your Budgeting Process Lack Accountability?
With the proper process, tools, and feedback mechanisms in place, budgeting can be a valuable exercise for organizations while helping hold organizational leaders accountable. Having a proper monthly variance review process is one of the most critical factors in creating a more efficient and accurate budget. Monthly variance reporting puts parameters around what is to be expected during the upcoming budget entry process.
Cost Accounting: the Key to Cost Management and Profitability
Managing the cost of patient care is the top strategic priority of most hospital CFOs today. As healthcare shifts to more data-driven decision making, having clear visibility into key volume, cost and profitability measures across clinical service lines is becoming increasingly important for both long-range and tactical planning activities. In turn, the cost accounting function in healthcare provider organizations is becoming an increasingly important and strategic function. This whitepaper includes five strategies for efficient and accurate cost accounting and service line analytics and keys to overcoming the associated challenges.