ICD-10: An Opportunity to Improve Financial Enterprise Performance Through Collaboration

Transcription

1 ICD-10: An Opportunity to Improve Financial Enterprise Performance Through Collaboration DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS. 1

2 Conflict of Interest Disclosure Joe Artime Ed Hock Surya Vadlamani Have no real or apparent conflicts of interest to report HIMSS 2

3 Learning Objectives 1. List strategies for analyzing your financial performance in ICD-9 to better prepare for ICD Identify financial pain points and provide solutions 3. Discuss how cash flow is impacted and where and how to manage the rest of your resources because of the delay 3

4 4

5 More than Coding and IT A Focus on Coding and IT Misses Substantial Sources of Potential Revenue Loss Transition Teams Neglecting Ares with High Financial Risk Estimated Incremental Impact on Net Revenue for 250-Bed Hospital in 2015 Contracting Denials Undercoding Overcoding Payment Errors First Year Impact $ K Poor MS-DRG mapping $ K 8-10% of procedure codes affected Unfamiliarity with adjusted medical necessity policies 10-25% increase in initial denials $470 K-1.2 M Insufficient specificity 10%+ charts will require more $ K Coder inexperience drives errors 10-25% increase in RAC takebacks $ K $ M Complexity increases payer errors 3-10% increase in error rate A/R Days Also at Risk Drop in Coder and Physician Productivity Growth in Rework Substantial A/R Impact Change in Charts Coded per Hour Increase in Physician Queries Increase in Inquiries, Adjustments, and Rejections Average Days in A/R Three Months after Transition Long Term 10-20% 10-20% % - 20% Current 2013 Sources: Advisory Board research and analysis; Advisory Board Financial Leadership Council, Revenue Cycle Performance Assessment, 2008; Robert E. Nolan Company, Replacing ICD-9-CM with ICD-10-CM and ICD-10-PCS: Challenges, Estimated Costs and Potential Benefits, October 2003; RAND, The Costs and Benefits of Moving to the ICD-10 Code Sets, THE ADVISORY BOARD COMPANY ADVISORY.COM 5 5

6 A Glimpse of the Future Losses Ensue Despite Attention to Coding and IT Upgrades Hospital Faces Revenue Losses Due to Insufficient Scope of Transition Activities Case in Brief: Norwood Health bed, two-hospital system in the Pacific Northwest Began ICD-10 transition planning in January 2012 ICD-10 Transition Established ICD-10 Transition Team CIO and HIM Director appointed as co-chairs Performed Vendor Impact Analysis Assessed all affected IT systems and contacted vendors Provided Coder Training Focused training on most complicated code changes Upgraded IT Systems Worked with vendors to ensure all systems compliant Educated Physicians and Staff Provided high-level overview of ICD-10 Insufficient Coder Staffing Chart backlog ensues due to double coding and coder training Incomplete Physician Documentation Coding insufficient despite coders readiness Denials Rate Increased Insufficient increases denials Lower Payment for Procedures New MS-DRG grouping reduces payment despite complete 2016 Employed Physician Losses Physician revenue declines from incomplete Required Redesign of Documentation Tools Team forced to reconvene to update structured tools $2.3 M Total revenue losses in first year associated with ICD Pseudonym 2012 THE ADVISORY BOARD COMPANY ADVISORY.COM 6 6

7 Denials Management Trading Partner Readiness Service Vendor Readiness Credit Lines Business Involvement Review your ERA Financial tables for CAS and claim reason codes corresponding to ICD-10 Consider conducting a qualitative, billing, and coding audit Leadership Support Revisit your current agreements with the banks providing you credit Understand what percentage of your current credit lines you are leveraging to support your organization Align you overall AR strategy to your ICD-10 strategy Review your managed care contracting strategy Strategy Conduct a managed care contract review for high-volume payers Define a process to measure reimbursements against contract negotiated amounts Review your cash posting process and reporting to ensure that you incorporate ICD-10 specific return codes 7

8 Denials Management Trading Partner Readiness Service Vendor Readiness Credit Lines Performance Metrics Prioritization Enablement Vendor Focus Determine your current avg. number of days an account is in AR, % of un-released claims, and avg. acceptance rate into your clearinghouse Establish a metrics-based process for Discharged Not Final Billed (DNFB) reporting Ensure that a plan is in place to upgrade your DNFB reporting to ICD-10 Start compiling a list of all your payer specific pre-bill edits (including Medicare) and analyze them for ICD-10 impacts Review your ERA financial tables for CAS and claim reason codes corresponding to ICD-10 Review the ICD-10 readiness of your collections and precertification vendors Understand your clearinghouse s strategy for the ICD-10 rollout Evaluate your denials management workflow Define performance metrics for your service vendors 8

9 Thank You! Joe Artime Ed Hock Surya Vadlamani Rhonda Taller 9