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 Lorraine Schnelle, CPA

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!

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.

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.

“The end is near” was a common thread throughout the recent American Academy of Professional Coders (AAPC) national conference in Long Beach, CA earlier this month—the end of ICD-9 that is. As  ICD-10 begins, many fear the worst as it will be an incredible challenge for healthcare organizations across the country adapt to the new codes.

BridgeFront’s VP of Sales, Mark Macdonell, attended the conference. He said, “One thing most don’t know is that the conversion will affect each and every healthcare employee, not just the coders. Even the American Medical Association (AMA) stated at the conference that it’s impossible right now to understand the breadth of changes for the healthcare community.”

Macdonell adds that ‘Armageddon’ came to mind as he listened to the woes of the healthcare organizations attending the conference and the speakers addressing the conversion to ICD-10 in the educational sessions.

The Centers for Medicaid and Medicare (CMS) website offers a quick overview of the ICD-10 requirements. The CMS says, “On and after October 1, 2013, ICD-10 codes must be used on all transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge. Otherwise, your claims and other transactions may be rejected, and you will need to resubmit them with the ICD-10 codes. This could result in delays and may impact your reimbursements, so it is important to start now to prepare for the changeover to ICD-10 codes.”

Despite the ominous outlook, there is light at the end of the tunnel. BridgeFront is in the process of developing a series of ICD-10 online courses for healthcare organizations. Stay tuned for more information on this new Revenue Cycle e-learning curriculum in the coming weeks.

For more information on BridgeFront’s current Revenue Cycle online education, go to www.bridgefront.com/solutions_education_revenue.php. You can also contact us directly. Call 866-447-2211 or send an email to info(at)bridgefront.com.