Sponsored by MiraMed Global Services. How to Proactively Address Coding Challenges

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1 Sponsored by MiraMed Global Services How to Proactively Address Coding Challenges

2 Sponsored by: Sponsored by MiraMed Global Services 2

3 CPE Credit Continuing Education Donna Fincher Webinar: 340B Updates Cynthia Dupree from Daffin and Tucker Sponsored by MiraMed Global Services

4 Presented by: Lyman G. Sornberger Chief Strategy Officer - Capio Partners President & CEO - LGS Healthcare Consulting For over 29 years Mr. Sornberger lead revenue cycle activities for The Cleveland Clinic and UPMC and has consulted with the largest health systems in the country. He has authored over 2,200 articles for HFMA, AAHAM, and other leading healthcare publications and has been a featured speaker at over 125 healthcare revenue cycle industry events. Sponsored by MiraMed Global Services 4

5 Questions - Polls - Survey You may ask questions at any time during the webinar Your questions will be answered at the end of the webinar and at a future conference call By polling our audience we can provide valuable feedback from your peers about our subject Polling results will be immediately available Please take our survey immediately after the webinar Sponsored by MiraMed Global Services 5

6 Bonus Q&A Conference Call Thursday October 15, 2105 Friday October 16, :00 am EDT 2:00 pm EDT Contact Phil Solomon For Conference Call Number and Dial in Pass Code Sponsored by MiraMed Global Services 6

7 Polling Question Which Super Hero Are You Most Like? Sponsored by MiraMed Global Services

8 Agenda Your fitness physical Scope of service line Post ICD-10 remediation timeline Budget assumptions example Risks: increased expenses and DRO, increased DNFB/AR & decreased cash ICD-10 analytics/high risk areas Outsourcing partnerships and tactical approaches Q&A bonus conference call schedule objectives Sponsored by MiraMed Global Services 8

9 Learning Objectives The importance of documentation and associated risk areas Understand costs to rework claims re: coding errors & cut your expenses Track performance through executive & operational dashboards Identify top KPI s and benchmarks that you need to know Create governance parameters for outsourcing with coding outsourcer How to pick the right coding outsourcing partner Sponsored by MiraMed Global Services 9

10 Sponsored by MiraMed Global Services 10

11 Polling Question Question How would you assess your systems readiness on October 1 st? Sponsored by MiraMed Global Services

12 The Future Beyond 2015 What s next? Healthcare s Super-Sonic Speed of Change Sponsored by MiraMed Global Services 12

13 Mitigate Risk Your Post ICD-10 check-up from the neck-up Validate your financial impact and cost Communicate and chart your findings Training strategy & plan What are your strategies? Create a plan and preventative protocol Sponsored by MiraMed Global Services 13

14 Scope of Service Line Education and Awareness - Leadership & Board Readiness Technology/Revenue Cycle/Clinical Documentation/People Impact Analysis Financial/Performance/Risk Mitigation/Strategies Implementation Strategy/Planning - Program Charter/Budget Estimates Timeline & Dependencies Sponsored by MiraMed Global Services 14

15 Scope of Service Line Implementation Mgt. Leadership - - Remediation Deployment End to End Testing Validation Enterprise Activation Live Optimization and Auditing - Process Reviews Documentation Reviews Go- Sponsored by MiraMed Global Services 15

16 ICD-10 Remediation Progression Remediation Timeline Major Remediation Activities Computer assisted coding evaluation Project management/governance IT remediation sign-off Remediation workgroups established Finalize ICD-10 training sessions roadmap and timeline Partnerships Establish PMO Establish project charter, work & communication plans ICD-10 Upgrades Application interface upgrades Ongoing Training for staff & physicians Identify ICD-10 super users Workgroups sessions Today ICD-10 Testing Test application and interface changes Generate test scripts and use cases Retest and obtain sign-off Ongoing staff & physicians ICD-10 training Go-Live & Post ICD-10 Support Execute change management plan Go-live Prep and execute Ongoing staff and physician ICD-10 training Post Optimization Post Monitoring Managing cost Denial Management 16 Sponsored by MiraMed Global Services

17 Financial Risk/Budget Example 300 Bed Hospital Total Budget $3.1M Capital $800K Patient Access $925K CDI $200K ($140K R) HIM $820K ($500K R) Training $400K ($250K R) Sponsored by MiraMed Global Services 17

18 Operational Gap/Risk $3.5M Missing Doc s $3.5M Doc Improvement $500K Contracting $600K Denials - Payment Errors $200K Coding Errors Example 300 Bed Hospital Sponsored by MiraMed Global Services 18

19 ICD-10 Analytics Providers overwhelmed discovering effort required for the ICD-10 transition A data-driven approach helps providers conserve resources and limit compliance costs minimizing disruptions Sponsored by MiraMed Global Services 19

20 DRG s At Risk Yes Orthopedics No Maybe Sponsored by MiraMed Global Services 20

21 External Exposure Vendor Readiness (C) Payer Readiness (C) Community Providers Coders (CAC / NLP / Offshore Outsourcing) Training Total Cost Sponsored by MiraMed Global Services 21

22 Polling Question Question What partner/process have you implemented to protect your financial outcomes? Sponsored by MiraMed Global Services 22

23 Partnership Strategy In-house Outsource On/Off Shore Dual Workflow Sponsored by MiraMed Global Services 23

24 Benefits and Risks Assess reimbursement shifts Coding Denials Contracting Engage providers in trends Assess revenue risk Handouts Promote strategies to mitigate risk Identify revenue maximization opportunities Sponsored by MiraMed Global Services 24

25 Fourth Quarter 2015 Assess Lessons Learned from Risk Mitigation Verify Revenue Impact Memorialize Future Training Seek Additional Improvement Opportunities: Denial Management Coding CDI, CAC, NLP Automated Coding, etc. Sponsored by MiraMed Global Services 25

26 2016 Benchmark Peer Performance Verify Revenue Impact Benchmark Seek Additional Improvement Opportunities Sponsored by MiraMed Global Services 26

27 2017 Establish Performance Targets Verify Revenue Impact Seek Additional Improvement Opportunities Manage Against Reimbursement Changes Sponsored by MiraMed Global Services 27

28 What to Continue Doing Communicate Monitor cash impact Train, train, train Identify problems/shift resources Sponsored by MiraMed Global Services 28

29 What to Begin Doing Trending-peer to peer Manage denial inventory Monitor underpayments Enhance training program Sponsored by MiraMed Global Services 29

30 CPE Credit Continuing Education Donna Fincher Webinar: 340B Updates Cynthia Dupree from Daffin and Tucker Webinar Recording is Available: GA HFMA website under the In Case You Missed It Sponsored by MiraMed Global Services

31 Bonus Q&A Conference Call Thursday October 15, 2105 Friday October 16, :00 am EDT 2:00 pm EDT Contact Phil Solomon For Conference Call Number and Dial in Pass Code Sponsored by MiraMed Global Services 31

32 Questions Do You Have Any Questions? Contact: Phil Solomon Vice President Global Services MiraMed Sponsored by MiraMed Global Services 32

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