The BridgeBlog

By Lorraine Schnelle, CPA

There’s one thing that will never change at your practice or organization. That is patient satisfaction is critical to your success. As ICD-10 preparation activities occur, it’s important to recognize how your transition plans impact the patient’s experience.

Prior to implementing ICD-10, pay special attention to the tests or procedures that are scheduled for October 1, 2013 and after. Both the physician office and scheduling staff need to ensure the correct coding system is used based on the patient’s date of service and the payer. There may be situations where both an ICD-9-CM and ICD-10-CM code will need to be provided. If the appropriate codes are not provided, it could cause multiple delays in scheduling the service and have a negative effect on patient satisfaction.

Wait times may become longer if patient intake must review the order and third party payer to determine which coding system is applicable. Additionally, patient satisfaction may be further affected if intake must contact the physician’s office to clarify the diagnosis code.

As payers receive claims on or after October 1, 2013, there may be delays in the business office and/or as the payer processes the claims. This may result in slowed payment by payer(s) before a patient receives their portion of the medical bill. This may also bear negatively on patient satisfaction.

Even today, prior to implementing ICD-10, if eligibility determination is delayed or not completed prior to a patient receiving service — and ultimately the payer determines it wasn’t a covered benefit — a patient may be understandably upset. This is why it’s important to ensure any eligibility determination processes and procedures, including dual-coding situations, are reviewed and revised to help minimize patient dissatisfaction.

Stay tuned for next week’s post on financial results and ICD-10. Ready, set, go!

By Lorraine Schnelle, CPA

During normal operating cycles, most healthcare organizations do more with less to maximize cash flow — which can be difficult. Now, healthcare faces a major and all-important transition: the implementation of ICD-10 on October 1, 2013.

You may be involved right now in a project related to preparing for ICD-10. Let’s discuss a few reasons to prepare for a change in productivity.

Your organization may upgrade or install one or more new computer software programs; perhaps for the conversion to HIPAA Version 5010 or the transition to an electronic health record (EHR), or another clinical or financial initiative. Some of these upgrades will help prepare for ICD-10; others will help support quality or other programs.

Both the installation effort and system testing requires time and effort. Not only will the information technology (IT) department be involved; but others may be asked to help build and test the system’s functionality. Downtime is also a real possibility and can affect productivity. However, having redundant systems in place can reduce the chances of system downtime during an upgrade or implementation.

Now, we can’t forget that it takes time to learn how to use a new computer system; this process will likely add to the disruption in individual productivity.

What are some issues you can anticipate with a system upgrade implementation? It’s likely that there will be many ICD-10 planning meetings to discuss:

• Computer system issues;
• Processes and procedures;
• Payer issues and contracts;
• Education planning and preparation;
• And other project steps as they relate to converting to ICD-10.

Depending on the amount of time people need for the planning process, individual positions may need to be backfilled with additional staff to maintain day-to-day operations. What can you do to help minimize the impact this will have on productivity?

There may also be a loss in productivity and performance immediately after the transition to ICD-10, as we work with both ICD-9 and ICD-10 codes. Practices and organizations should prepare for processing claims with both ICD-9 and ICD-10 codes, leading to a dual-coding environment.

Adopting and applying these new processes and procedures will take time. How will you help ensure there is time to review and revise your organization’s processes and procedures prior to ICD-10?

Stay tuned for next week’s post on patient satisfaction and ICD-10. Ready, set, go!

By Peter Cizik

Judging by the number of calls we’re getting, many organizations impacted by HIPAA are taking a serious renewed look at their HIPAA compliance stance. Maybe you should too. It may be because:

1. The continued publication of data breach stories (there are too many to list in our latest HIPAA Flash e-Newsletter);
2. OCR audits are fully ramped up now
3. The requirement to attest to HIPAA compliance as a requirement of the meaningful use incentive program
4. State Attorney Generals are trained to audit on HIPAA and many see fines as a new ‘income’ source for their state
5. Recent visibility of breaches and the time and money it takes to deal with them

I don’t have to remind anyone reading this that healthcare is a highly regulated industry and it’s not going to get any better. HIPAA is “low hanging fruit” from a compliance standpoint—as long as you treat it with the ’seriousness’ it deserves. Get your documentation ducks in a row and train your staff.

I didn’t say it would be easy—it does take time to get the proper documentation in place and actually follow it. You already have to train employees on other topics annually—add HIPAA to the list. Don’t view it as a “check-off” item—make sure the content really meets your needs, is current and updated, and tie it to what you do internally to manage HIPAA compliance.

One size does not fit all. The people calling us today had training in place, but violations were still occurring. The programs were too long (couldn’t get staff to take them), were not up-to-date, were too generic (didn’t incorporate organization-specific information), and the person delivering them was too busy to keep up or all of the above.

Do yourself a favor—make sure your organization is as prepared as possible. We’re all staring at the looming ICD–10 transition in 2013—the last thing you need is to be distracted with HIPAA violations and breaches. BridgeFront has the tools and resources to help you each step of the way.

Visit our website for more information about our HIPAA compliance products and services. You can also contact us directly by emailing info@bridgefront.com or call (866) 447-2211.

The Centers for Medicare and Medicaid Services (CMS) recently announced it will provide a 90-day grace period for enforcement of HIPAA 5010. This doesn’t mean providers don’t have to comply with the requirement.

CMS will accept complaints about non-compliance with the rule and could require Covered Entities to show evidence of a good-faith effort to comply. In addition, any claim or bill submitted after January 1, 2012 not in HIPAA 5010 will still get rejected, but this delay will allow for resubmitting in the appropriate format without penalty.

Below are four tips to ensure reimbursement continues to occur at your organization after January 1, 2012:

1. With HIPAA 5010, the 837 transaction set now requires anesthesia services to be reported in minutes instead of units.

2. With the start of HIPAA 5010, the 835 transaction set offers new data elements; these will provide payers the ability to allow direct billing by a Medicaid agency to other health plans.

3. For Version 5010, the 837 transaction set provides for a present-on-admission indicator related to each diagnosis code.

4. The 270/271 transaction sets, with Version 5010, clarify instructions for patient hierarchy, such as when a subscriber is a patient and when a dependent is a patient.

For more HIPAA 5010 tips and information, sign-up for our monthly tips handout.

By Kent Lane

You get the OCR audit notification letter and the panic begins. You are one of the ‘unlucky’ providers or health plans to be audited as part of the OCR’s HIPAA HITECH audit program; what do you do first?

During & After the Audit

On the OCR website, it details each step of the new HITECH audit program, including a timeline of events. Below are five critical steps:

1. Required documentation of your privacy and security compliance efforts (see below for more information)
2. Interviews with key personnel on site, and observe processes and operations to help determine compliance
3. Following the site visit, auditors will develop and share with the entity a draft report
4. Prior to finalizing the report, the covered entity will have the opportunity to discuss concerns and describe corrective actions implemented to address concerns identified
5. The final report submitted to OCR will incorporate the steps the entity has taken to resolve any compliance issues identified by the audit, as well as describe any best practices of the entity

Documentation Must Include Policies, Procedures & Training

In accordance with HIPAA regulations, all Covered Entities and Business Associates must institute and document its policies, procedures, and practices—which includes initial and refresher staff training—to improve the privacy and security of protected health information (PHI).

Your training must address privacy and security regulations:

• Privacy training must include all elements of the federal, state and organization privacy regulations
• Security training should cover topics such as, the use of virus protection software to prevent or lessen the threat of malicious software; login and password management; and how to respond to security incidents
• The training should also include your organizational security policies and procedures

BridgeFront HIPAA Online Training

We offer simple to use, cost effective online training and guides. Training is easily modified to include your policies and procedures. We guarantee our training and guides will pass your audit.

For more information on our HIPAA training and education, visit us at www.bridgefront.com or contact us directly. Send an email to info@bridgefront.com or call (866) 447-2211.

In a recent poll and study on the ICD-10 transition, 75% of healthcare professionals indicated deep concern over the conversion, while another 50% expect a loss of revenue. Respondents are concerned about staff training, understanding the new ICD codes, and increasing denials. Nearly half of all financial leaders who contributed to the study by HealthLeaders Media, ICD-10 Puts Revenue at Risk, anticipate a revenue loss of some kind from ICD-10. Even more significant, is that they anticipate losing margin over the next few years. The Importance of Education In the ICD-10 Puts Revenue at Risk study, Albert Oriol, the VP and CIO of Rady Children’s Hospital and Health Center in San Diego comments on the amount of learning that must take place prior to the conversion.

He says, “Many have compared ICD-10 to Y2K, [but] ICD-10 is more complex. It requires staff along the care continuum to learn and use a new order of magnitude of diagnostic and procedure codes—from the scheduler, to the physician, HIM professional and the biller. Unquestionably, ICD-10 introduces an added layer of complexity to the multitude of challenges already at hand.”

BridgeFront case studies can prove that revenue cycle staff education can improve employee productivity and increase accuracy; well-trained employees also have fewer denials, rejections, and re-bills. Staff education can clearly reduce the negative impact healthcare providers are expecting after the transition to ICD-10.

Informational Web Portal

BridgeFront recently announced its ICD-10 and HIPAA 5010 informational portal, located at www.icd10-education.com. Healthcare professionals can visit the website for complimentary resources on the conversions to ICD-10 and HIPAA 5010. Visitors can sign-up for a free on-demand webinar and a monthly preparation email newsletter.

ICD-10 and HIPAA 5010 Education by BridgeFront

BridgeFront also announces its ICD-10 and HIPAA 5010 online education. For more information, complete this form or contact us directly. Send an email to info@bridgefront.com or call 1-866-447-2211.

There are two new ‘HIPAA sheriffs’ in town…both ready to monitor and audit your HIPAA compliance practices. Recently, the OCR granted the authority to assess healthcare’s HIPAA compliance practices to State Attorney Generals (AGs) and the firm KPMG under the 2009 HITECH Act.

Steps to Survive a HIPAA Audit

In preparing for a visit from your State AG or a HITECH auditor, BridgeFront and the OCR recommend these steps:

1. Implement an annual employee training program
2. Ensure you’ve documented patient information safeguards
3. Review privacy and security policies and procedures
4. Vigilant implementation of policies and procedures
5. Regular internal audits and risk assessments
6. A prompt action plan to respond to data breach incidents

OCR Announces State Attorney General HIPAA Authority

This spring, the OCR announced its new HIPAA training program for State Attorney Generals (AGs). Under the 2009 HITECH Act, AGs now have the authority to bring civil actions on behalf of state residents for HIPAA violations.

“Most state AGs are elected into office…which means there is more pressure to pursue HIPAA violations, particularly if there’s a ‘good story’ behind the data breach. They want to be seen as protecting the little guy,” says Jeff Drummond, health law partner in the Dallas office of Jackson Walker, LLP.

HITECH Auditors Set to Begin

Last week, the Department of Health and Human Services (HHS) awarded a $9.2 million contract to the consulting firm KPMG to launch its HIPAA audit program as mandated by the HITECH Act. The HHS will work with KPMG to roll out the program in three phases, says Susan McAndrew, OCR’s deputy director for health information privacy…starting later this year.

“This is just another opportunity for covered entities to take a moment for a self-assessment,” McAndrew says. “This will help them down the road in terms of building their own capacity for a robust compliance program…”

In a recent BridgeFront compliance study more than 60% of participants indicated they use online education as part of their compliance program.

BridgeFront is the leading provider of compliance online education. Visit us on the web for a free course trial at www.bridgefront.com/trial or contact us directly. Send an email to info@bridgefront.com or call (866) 447-2211.

By Lorraine Schnelle, Co-Founder and EVP of BridgeFront

Remember sitting or standing in a circle and whispering something into the ear of the kid next to you…then watching the faces as your message was passed from person to person. The looks on each face ranged from confusion, surprise, and laughter as you all played the “telephone game.”

This picture popped into my head as I was thinking about a survey question I asked participants in a recent online webinar. The webinar was on educational tools and techniques. The attendees were primarily healthcare finance professionals—many of whom are responsible for managing one or more areas of the revenue cycle.

The survey question was, “What educational activity do you rely on most when delivering staff education?” The top two answers were on the job (OTJ) and one-on-one instruction.

Sounds to me like it could easily turn into the “telephone game” played out in our everyday work world. Don’t get me wrong, the National Training Laboratory found the average retention rate of students participating in “practice by doing” educational activities is 75%. Their study re-enforces the value of OTJ training.

However a word of caution, don’t rely on OTJ or verbal instruction as the main ‘source of truth.’ Because this same study found that only about 5% of what a student hears is retained.

Ensure you have additional educational activities and materials that are and will be used by your staff to support and re-enforce key learning concepts. This material can be in form of online courses, written procedures, video demonstration, work flow diagrams, user manuals, screen shot job aid, etc.

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For more information about BridgeFront’s online education, go to www.bridgefront.com or contact us directly. Call 1-866-447-2211 or send an email to info@bridgefront.com.

By Lorraine Schnelle, Co-Founder & EVP of BridgeFront

Improving the total patient experience is on the agenda of most healthcare organizations today. A newly published whitepaper suggests that customer service—throughout the revenue cycle—plays a vital role in the patient experience.

According to the whitepaper, The Revenue Cycle: An Essential Component in Improving Patient Experience by The Beryl Institute, good customer service—at each step of the revenue cycle process—is often more recognized by patients than quality healthcare; and good customer service often leads to increased patient satisfaction.

A typical revenue cycle in healthcare includes coding, insurance verification, third-party payers, financial counseling, billing, payment, or follow-up and collection. The whitepaper suggests that every step of the revenue process impacts the patient experience—beginning with the patient’s first interaction with the organization in scheduling his/her appointment, to discharge and communications with the finance department.

Here are four suggestions, noted in the whitepaper, for healthcare organizations to improve customer service at every step of the revenue cycle process:

1. Establish patient loyalty as an organization-wide goal
2. Educate employees on the new initiative
3. Train employees on essential interpersonal and soft skills
4. Ensure outsourced business providers also understand the new goals

The whitepaper’s research stems from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) annual survey. The HCAHPS survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.

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BridgeFront is a leading provider of revenue cycle and customer service online education. For more information on BridgeFront, go to www.bridgefront.com. If you have specific questions, please contact us directly. Send an email to info@bridgefront.com or call (866) 447-2211.

By Nancy Friedman, the Telephone Doctor

We hear what bugs people a lot in customer service – and often. One of the most common compliants we’ve heard recently is that we’re told “no problem” from those serving us on the phone or in-person. Instead of a genuine “thank you” or something else that might be more appropriate, some insist on saying “no problem.”

When a customer is asking for something, most would rather hear, “I’ll be happy to get that for you” instead of “no problem.”

Did you ever wonder where the expression “no problem” came from? Ever been on a cruise? Well if you have, you know that if you wanted six more desserts, the waiter will tell you, “No problem.” In fact, everyone seems to be saying “no problem” everywhere on the ship for just about everything.

And, when you come down to it, it’s not a terrible thing to say to someone. Now, there are those that don’t find it offensive; however, it seems as though there are many more who do! It’s not a dirty word. It’s not a swear word. It is, however, an inappropriate word. It started in the islands and made its way to our country.

So today, we’re concentrating on eliminating “no problem” and sharing a few other phrases that are more “customer friendly.” Try using words that turn people on instead of turning them off. Example: The other day in a restaurant, I asked for some water without ice. And I got the old, “No problem.” The person with me asked, “Why would requesting water without ice be a problem?” I was used to the expression so I didn’t give it too much thought.

A more appropriate answer to my request might have been, “Certainly. I will get that for you.” Or, even mirroring my request like, “Water with no ice? My pleasure.”

So, when you are tempted to offer up a “no problem,” it is best you remember the public would like a genuine and simple “thank you.” Now why is that a problem?

Reprinted with permission of Telephone Doctor Customer Service Training, St. Louis, MO. Nancy Friedman, president, is a featured speaker at association and corporate meetings. She has appeared on OPRAH, The Today Show, CNN, FOX News, Good Morning America, CBS This Morning and many others and has written articles for USA Today and the Wall Street Journal. For more information, log on to www.telephonedoctor.com or call 314-291-1012.

For more customer service tips, explore BridgeFront’s Communication Skills e-learning. Visit our website at www.bridgefront.com, send an email to info@bridgefront.com or call 1-866-447-2211.