The BridgeBlog

By Lorraine Schnelle, CPA, BridgeFront

Today, on Valentine’s Day 2012, CMS warmed the hearts of those pushing for change in the ICD-10 compliance deadline. Marilyn Tavenner, acting CMS Administrator of the CMS, told reporters the CMS will “re-examine the timeframe” through a rulemaking process. However, don’t stop preparing now; we don’t know what and if anything will change.

There are so many healthcare initiatives in play today including:

• Regulatory and reimbursement changes
• Accountable care organizations and medical homes
• Electronic health records
• Meaningful use and more

All of these require the time and attention of you and others within your practice or organization…and the good thing is many run parallel to the efforts needed for implementing ICD-10.

A critical step to ICD-10 planning and preparation is to integrate any related existing initiatives (such as the ones listed above) into your ICD-10 implementation plan. Why create more work when you can consolidate and collaborate to support a positive outcome for all?

To get from here to there requires planning. However, this isn’t a new concept for you or your organization. You are already experts in these steps. Just apply the same methodical, comprehensive approach you’ve used in the past. Now, what needs to be done to get the desired result?

1. Ensure you are forming multi-disciplinary teams to work on specific tasks.

Include both leadership and staff perspectives as solutions and approaches are discussed and decisions are made. The old saying “variety is the spice of life” is especially true here as it relates to including team members who bring different skill sets, expertise and experience to the table.

2. Grab your comprehensive listing of the vendors and software applications your practice or organization is currently using.

This list will be crucial in determining the business partners you need to reach out to and engage in your organization’s ICD-10 implementation project.

3. Dust off your communication and education protocols and procedures.

Validate the current methods and timing of communicating information will be sufficient. This is big—lots of people need to be aware, engaged and prepared to get the job of implementing ICD-10 done.

Stay tuned for next week’s post when we discuss more ways to prepare for ICD-10. Ready, set, go!

By Lorraine Schnelle, CPA, BridgeFront

Industry experts suggest the ICD-10 conversion will be more time-consuming, costly, and complicated than the preparation for Y2K. Some studies indicate the cost of transitioning to ICD-10 for a hospital can be between $1 million and $5 million, and for a large healthcare system, it could amount to over $5 million.

During the transition, you may see added expenses in IT, document design and print, training and education, and claim processing, to name a few.

Personnel and Software Costs

It is imperative that software vendors, such as claim clearinghouses, eligibility verification, and medical necessity validation programs are ready for ICD-10. This will require your organization, software vendors, and third party payers to work together to prepare for ICD-10, and may result in additional personnel and software costs.

Training and Education Budget

Since this is such a significant change, many individuals will need ICD-10-specific education. Staff must train on all new procedure and software applications, too. As part of your organization-wide implementation planning and budgeting, identify the required training for each role along with the associated costs.

Staff Overtime Expense

As with any major initiative, individuals will be “wearing many hats” to help prepare for ICD-10, and this may result in an increase in overtime expenses. For example, overtime hours may be required to ensure staff can complete the required training. In addition, staff may need to work overtime to fill in for employees that are working on specific implementation projects, attending training sessions, and/or participating in ICD-10 meetings. Overtime expenses will most likely be higher than the current level prior to October 1, 2013.

Claims Processing and Denials Management

Ensuring current claims are submitted and paid in a timely matter is especially important as we near October 1, 2013. Many industry experts are recommending organizations reduce their accounts receivable levels prior to ICD-10. This is because post-implementation claim processing time and denials—such as medical necessity denials—may initially increase due to provider or payer issues. Regretfully, this may have a negative effect on cash flow and the cash reserves your practice or organization has to pay its bills.

What are ways you can help minimize any potential negative financial outcomes and begin to proactively help during your organization’s transition to ICD-10?

Stay tuned for next week’s post on preparation steps for ICD-10. Ready, set, go!

As the twitter chatter begins, the speakers practice their presentations, and the walls in the convention center begin their initial ascent—BridgeFront is also gearing up for its first time exhibiting at the HIMSS national conference.

With over 35,000 healthcare IT and management systems professionals expected, we are extremely excited to make new connections and eager to catch up with current clients and partners.

You can find us in exhibit hall G at booth #14147 near the ICD-10 Knowledge Center, a new feature for the HIMSS national conference. It’s a great place to see expert presentations and make a quick stop at the BridgeFront booth to learn about our new ICD-10 Preparedness Education, accredited by AHIMA and AAPC.

Also, make sure to ask about our new meaningful use education and mobile learning technology. At our booth, you’ll also find some great giveaways too.

To learn more about BridgeFront, visit us at booth #14147 during the HIMSS conference, or go to our website at www.bridgefront.com. Contact us directly by calling 1-866-447-2211 or email info@bridgefront.com.

Visit the HIMSS12 website at www.himssconference.org for more information on the conference.

What is your most anticipated event or feature at HIMSS12?

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 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.

By Peter N. Cizik, CEO of BridgeFront

Let’s talk about the new term, “data liquidity.” No—it’s not some new physics concept. For those of you in health information technology, it’s a term you may begin to hear.

As the industry lurches forward trying to connect the many unique health information systems (EHRs, CPOE, eRx, disease registries, HIEs, etc.), there is a push to standardize and streamline information, so all the systems can talk to each other.

Hence—make data more “liquid” so it can easily flow from one system to the other. This is clearly a necessary step to realize the goals of increased patient safety, better population health, and decreased health system cost.

One huge hurdle that has yet to be satisfied is the privacy and security controls to prevent unintended consequences of all this “open access.” As data becomes more liquid, the potential consequences of a breach grows exponentially, since the volume of data flowing within the entire system is considerably higher.

At this point, I don’t think anyone has the “right” solution—both sides are passionately arguing their position—on the surface, fully integrated systems that allow for the free flow of information sounds like the absolute right answer. What makes privacy advocates cringe are the unintended consequences and potential abuse that could occur if information falls into the wrong hands.

They argue that people need to have the power to restrict where their information flows. I don’t have the answer—but you should be aware of the issue and get involved in the debate.

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If your organization needs help with HIPAA compliance, BridgeFront is your number one resource. We can step in, initiate a compliance program, or move the process along; we can also take a back seat and simply support your staff during the process.

Our consultants are experts in both HIPAA Privacy and Security regulations. We can quickly assess your organization’s level of compliance and help you develop a plan to eliminate any risks. We offer HIPAA risk assessments, certification, and consulting services.

Get started by downloading a free HIPAA compliance self-assessment. Then, learn more by visiting us online or contacting us directly. Call (866) 447-2211 or send an email to info(at)bridgefront.com.