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!

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 Lorraine Schnelle, CPA

Flash Forward to 2014

Flash forward to February 1, 2014, four months after your practice or organization has started using ICD-10 codes. As you review how well the transition went, what do you see?

Was your practice or organization successful in…maintaining coding accuracy and productivity; retaining a stable accounts receivable position; and sustaining a viable cash flow?

These three goals can’t be achieved without support from you and others during the implementation process. It’s the hard work and execution by many individuals in various roles that will lead to your organization’s successful transition to ICD-10.

It is imperative that everyone understand how they can influence financial outcomes and, more specifically, support workflow processes. To have a “This is very important to our success” attitude rather than a “This isn’t my problem” approach as it relates to the implementation of ICD-10 is crucial to a smooth transition. You must take ownership and personally commit to proactively preparing for this significant change. Otherwise, the view on February 1, 2014 may be disappointing and frustrating.

There are a lot of cogs in the ICD-10 wheel, focusing on only the coding aspect and skipping over the billing and technology outcomes; for example, you could see increased claims denials, declines in productivity, and other negative results. It will require hard work by many individuals in various roles to ensure your practice or organization successfully transitions to ICD-10.

By understanding the broad impact this change has on healthcare and, more specifically, your practice or organization, you can play a major role in minimizing potential negative outcomes, and begin to proactively work toward:

• Maintaining coding accuracy and productivity
• A stable accounts receivable position
• Sustaining cash flow

Over the next several weeks, we will creating additional blog posts focusing on the steps you can take within your organization to make this transition as smooth as possible. Ready, set, go!