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Many hospitals and health systems have been gearing up for the transition from the ICD-9 to ICD-10 code set by focusing on clinical documentation improvement programs and implementing extensive training and education for clinicians and coders. On March 31, however, Congress passed the Protecting Access to Medicare Act of 2014. While the bill prevented a 24 percent cut in Medicare physician pay, it also included a seven-line provision to delay the conversion to ICD-10 by at least one year. In light of this delay, healthcare leaders should consider a fresh look at plans, timelines, and critical decision-making, evaluating their current state of readiness against other organizational initiatives.
Here, Chris Armstrong, principal and ICD-10 practice leader for Deloitte Consulting LLP, and Steve Burrill, partner and health care provider advisory practice leader for Deloitte & Touche LLP, offer strategies to consider for determining the best path forward during the delay.
Chris Armstrong: Many organizational leaders are evaluating the work they’ve completed and determining how time, efforts, and costs can be optimized with the delay. A key concern will likely continue to be ensuring that all systems are go. Everything needs to be working properly, so that claims can be submitted accurately and payment reflects the level of services completed. Using this as the anchor for decision-making, leaders might need to re-forecast their current spend, resource alloca¬tion, ability to maintain testing activities without dupli¬cative efforts, and potential costs of continued momentum. Decisions related to education and training program timelines also need to be reviewed, as stakeholders may not be willing to engage as initially planned or training programs may need to be repeated closer to the new implementation date.
Steve Burrill: It’s also important to recognize that even with the delay, the transition probably won’t go as smoothly as expected, and payment is likely to be affected. Leaders should consider adopting a “Let’s turn the delay into an opportunity” mind-set and evaluate what can be accomplished now that the original deadline has been changed. These elements can be brought into revised remediation plans.
Armstrong: Many organizations had started to collabo¬rate with payers, clearinghouses, and third-party entities by testing claims through the end-to-end process. Many providers are contemplating how they can capitalize on this delay and engage in enhanced testing to enable true transaction evaluation while also conducting deeper analytics. Reaching out to third-party entities to confirm willingness to continue testing and expanding participa¬tion may be beneficial to organizations who continue their momentum.
For providers deep in implementation, ICD-10 has shown to be more complex than originally expected, and the extended timeline could allow for more thorough testing of processes and technologies. The previous timeline had many using a hurried, risk-based approach that was focused only on the most critical areas.
Burrill: Providers that maintain momentum could be able to achieve goals they previously set but then altered due to time constraints, such as the ability to thoroughly practice ICD-10 coding, produce usable test data, or conduct dual coding for a full nine months to a year prior to implementation. Also, the art to being ready is having both the people and tools in place to analyze the results. Many organizations have yet to take the time to not only identify the resources for this analysis but also deter¬mine whether performance will align with expectations.
Armstrong: As a part of remediation activities, we were helping clients establish baseline metrics to compare performance pre- and post-go-live and monitor trends, just as you would with a system implementation. These metrics can be put in a dashboard-type tool so that vari¬ances can be easily identified. Organizations not currently using such metrics in an easy-to-track tool can use the additional time as an opportunity to start critical metric monitoring. Additionally, organizations should consider whether they need to assess vendor contracts and retention/ incentive programs to determine extension provisions and updates to accommodate the extended timeline.
Burrill: We’re already starting to see clients revise timelines to refocus training programs on documenta¬tion improvement, regardless of the code set. Accurate documentation has always been important but has never been an easy task for physicians and other clinicians. There are advantages organizations can gain in taking the results of native coding outcomes and early training findings and incorporating them into a more advanced clinical documentation program.
Armstrong: The timeline extension may enable organizations to better advance their efforts in blending Meaningful Use with ICD-10 clinical documentation. Taking this extra time to link documentation requirements to order sets, smart templates, and documentation tools could give organizations a way to leverage existing training materials and retain knowledge. Additionally, the extension may allow more time for providers to actually realize benefits of CAC (computer-assisted coding)—a technology that was perhaps not an option with the original deadline.
Armstrong: Many organizations have spent a lot of time in the planning process and haven’t thought about: “Once I go live, I don’t want to eliminate the resources I just garnered.” It’s important to consider how to best use these resources both with the delay and after the new ICD-10 compliance date. When the delay occurred, many organizations were just beginning to consider an organizational “go live” command center focused on system issues, denials, coding questions, and underpay¬ment analysis. It could be beneficial, for example, to have team members who can provide just-in-time education when coders are struggling with code selection or docu¬mentation issues. Additionally, the results of early adop-tion indicated that expanding ICD-10 practice time can dramatically impact productivity and code accuracy and minimize payment variances. Taking the time to deep dive into the more detailed data reporting and analytics could give organizations a chance to garner expertise they may not have had as of the previous deadline.
Burrill: All in all, it isn’t likely that this is a gloom-and¬doom scenario. In many respects, it’s the beginning of the next phase. We’ve all worked very hard to get to this point. The healthcare industry now needs to understand the value that can be captured. The industry could be much better served with all of this new information. We’re likely to have a better understanding of how to deliver better care, even though we could have some challenges that go along with having something that is more robust and stronger. We might also look back at this five years from now and say: “Yes, it was lot of hard work, but we got through it, and look at the better system we have today.”
For more information, visit resources for healthcare providers.Content for this Business Profile is supplied by Deloitte & Touche LLP.
HFMA is the nation’s leading membership organization for more than 40,000 healthcare financial management professionals. This Business Profile is funded through advertising with leading solution providers.
This published piece is provided for advertisement purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions of those profiled are those of the individual and not those of HFMA. References to commercial manufacturers, vendors, products, or services that appear do not constitute endorsement by HFMA.
Publication Date: Thursday, May 01, 2014
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
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.
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
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.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
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.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
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.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
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.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
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.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
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.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
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.
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.
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.
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.
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.
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.
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.
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