Safeguarding the Revenue Cycle from ICD-10. January 22, 2014 James W. Akimchuk Jr.

Transcription

1 Safeguarding the Revenue Cycle from ICD-10 January 22, 2014 James W. Akimchuk Jr.

2 Safeguarding the Revenue Cycle from ICD-10 Most healthcare providers are focused on how to be prepared for the October 1, 2014 transition to ICD-10 System readiness Documentation and training Payer readiness 3

3 Safeguarding the Revenue Cycle from ICD-10 Little attention paid to what happens after the transition. Impact on cash flow Changes in workflow Impact on productivity 4

4 Culbert ICD-10 Program: The Clinical Enterprise Approach Clinical Workflow Training/ Education ICD-10 Strategy Information Technology Patient Access & Revenue Cycle 5

5 Culbert ICD-10 Program: The Clinical Enterprise Approach ICD-10 Implementation Financial Monitoring Workflow Redesign Training Systems External Impacts Policies/ Procedures PM EMR 6

6 Managing impact will require a solid understanding of organizational performance before, during and after implementation Significant complexity required to mitigate the impact of ICD-10 All areas of an organization are impacted 7

7 Culbert ICD-10 Program: The Clinical Enterprise Program PHASE ONE: Program Development Establish governance Ensures resources The revenue cycle is impacted at all levels of transition planning PHASE TWO: Impact Assessment Clinical, Rev Cycle, IT, Training Inventory of systems and risk areas PHASE THREE: Project & Implementation Planning Organize integrated project PHASE FOUR: Implementation Implementation Integrated testing Training 8 PHASE FIVE: Stabilization & Optimization Stabilization and Optimization

8 Phase 1: Program Development Goals: Representation by all constituents of the revenue cycle 1. Establish governance 2. Provide decision making guidance 3. Establish a communication plan 4. Ensure necessary resources from each functional area are allocated Create a steering committee comprised of leadership representing: Revenue Cycle Finance Coding Clinical Informatics / Clinical Documentation IT: Patient Access, Clinical & Revenue Cycle Training Compliance 9

9 Phase 2: Impact Assessment Goals: 1. To provide an integrated assessment of how ICD-10 will impact overall operations across all environments, rather than viewing each functional area within a particular silo. From this assessment, gaps are identified that will require action throughout the project planning and implementation phases of the ICD-10 conversion. Revenue Cycle / Finance Information Technology Workflow/Operations Documentation and Training 10

10 Phase 2: Impact Assessment Identify gaps to be managed as part of your ICD-10 transition Impact on cash flow Impact of payer strategy Plan B Cost to implement Vendor upgrade approach Functional gaps Cost Timeline Financial Systems Training Workflow Physicians Business System AND Workflow Clinical data Revenue cycle Identification of lost efficiencies Overlap 11

11 Phase 3: Project & Implementation Planning Participation by all areas of the organization is necessary to fully understand potential impacts Goals: 1. Develop project plan, timeline, resource requirements, change management and budget 2. Develop communication program 3. Define training program 4. Define critical success measurements/metrics 5. Develop framework for integrated test plan for internal and external areas of impact 6. Obtain steering committee approval for ICD-10 implementation approach, and requisite training by all staff 12

12 Phase 4: Implementation Common Implementation Tasks: System updates and/or upgrade (ex. Medcin, SNOMED, templates, electronic and paper claims/remits, and reports) Interface modifications & testing Physician documentation training HIM and coding training Revenue cycle staff training Unit testing Integrated testing: interfaces, clearinghouses, EDI partners Development of new reports The go-live plan MUST include real time monitoring of issues, including patient visit/encounter volumes, physician productivity, clinical documentation, HIM and coding productivity, interface error logs, claim edits, claim denials, remittances, etc. 13

13 Phase 5: Stabilization & Optimization Performance metrics throughout implementation and go-live will be central to identifying potential risks and opportunities for improvement. Metrics combined with direct communication with leadership of the cross-functional areas involved in this project will be used to stabilize and optimize performance through additional training, workflow redesign and system modifications. 14

14 Preparing for an Increase in Denials ICD-10 s specificity and scope will likely have an immediate impact on denials: Significant increase in possible codes Changes in schema Provider interpretation Payer interpretation 15

15 Preparing for an increase in denials Steps to minimize impact: Evaluate your current diagnosis coding patterns to better understand expected impacts Optimize denial analyses and reporting to ensure timely feedback Incorporate findings into ongoing training during and after implementation. 16

16 Anticipating the impact on reimbursement Understand the impact of your choice: Choice of Dx codes will impact overall reimbursement levels Increased specificity is expected to result in increased reimbursement Differing payer interpretations will require a more sophisticated approach to Dx coding 17

17 Planning for a decrease in productivity ICD-10 will likely result in decreased productivity: The change from ICD-9 to ICD-10 is SIGNIFICANT Retention will be impacted by timing and completeness of training Potential Impacts: Longer claim lags Time to code Internal scrubber edits 18

18 Training Significant training is needed at all levels Clinicians Coders Office/Administrative staff Various methods of delivery One on one Small group sessions Lectures 19

19 Training Know how you will handle dual coding Billing system requirements/capabilities Payer ability to accept Organization s ability to dedicate resources Timing 20

20 Start Now It s not too late Preparing for ICD-10 takes time It will cause significant disruption for internal and external resources Preparation efforts will be empowered by monitoring ongoing performance against baselines Must be timely and actionable Train Train and Train some more!!! 21

21 Safeguarding the Revenue Cycle from ICD-10 Questions and Discussion 22

22 Thank you James W. Akimchuk, Jr, Vice President Revenue Cycle Services Jim has over twenty seven years of experience in healthcare focused on improving revenue cycle operations for academic practice plans, large group practices, hospitals and ancillary services. His strong combination of operations, billing and technology experience enabled him to transform the Massachusetts General Physicians Organization from an underperforming, de-centralized billing organization, into a wellfunctioning central billing office which earned recognition as a top revenue cycle performer by the University Health Consortium. Jim played an integral role in Partners HealthCare s selection of a core billing system which supported all revenue cycle needs throughout the health system. Since joining Culbert Healthcare in 2006, Jim has developed its Revenue Cycle Assessment methodology which has been deployed in over 25 academic medical centers. He has also developed and deployed Culbert Healthcare s Clinical Enterprise Approach to ICD-10 assessment and remediation. This approach employs an integrated solution across the entire organization focused on the four key areas impacted by ICD-10 Revenue Cycle Operations, Information Technology, Training and Education, and Clinical Workflows. As Vice President of Revenue Cycle Services, Jim is responsible for a team of Revenue Cycle consultants who focus on workflow optimization, business process improvement, ICD-10, vendor selections and interim management. 23