January 15, 2013

Get Up and Get Going to Ensure Your Organization’s Fiscal Health

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What’s your strategy for testing with ICD-10? Do you know all the players in your “trading-partner community”—a phrase used by Ellen VanBuskirk, senior principal of business consulting for Infosys Public Services, during ICD10Monitor’s January 8 Talk Ten Tuesday broadcast. It’s essential that the whole industry define their community, she says, and identify all of the critical services and access points for the claim.

 

Currently, the industry is not “spending a lot of time thinking about and developing a more strategic approach or roadmap and strong governance for trading partners.” However, it is important to mutually identify what providers and payers alike consider a successful test and how issues will be resolved that arise when there’s a lack of alignment. Allow at least 9 to 12 months for testing even though testing time will vary by organizational size.

“There are more and more inconsistencies due to different business models. It’s a dilemma,” says VanBuskirk.

One of the challenges is that providers and payers may have different concerns and priorities. As Stanley Nachimson, principal of Nachimson Advisors, explained, “Providers need to be concerned about revenue. Payers need to worry about operational risks.”

For example, providers are considering questions like these: How much more time will it take for coding under ICD-10? Will the time to payment be longer and, if so, how much longer?

“Health plans will have to look at productivity measures and changes in payment cycles. HEDIS measures, which are used in managed care plans, and quality bonuses will change,” states Nachimson.

While there may be many challenges in the months ahead, the payoff should be worth the effort. According to Talk Ten Tuesday guests, the major benefit will be a more effective exchange of healthcare data among all trading partners. Better coding and documentation will produce better data and this, in turn, will produce significantly better clinical details on a population basis and individual basis.

Status of Readiness

 

Sue Bowman, senior director of coding policy and changes for the American Health Information Management Association (AHIMA), brought good news to the program in relation to implementation readiness. Many organizations are making good progress, said Bowman, and those that didn’t slow down when the Centers for Medicare & Medicaid Services announced the one-year delay are moving right along. Even those that did slow down have picked up their pace.

However, some rural and smaller providers aren’t as far along as needed, reported Bowman, nothing that they haven’t even done their initial assessments. They need to be motivated to take their first step.

“It’s like packing for a long trip. If you wait until the last minute, you may be rushed and forget key items,” Bowman stated. “The plane will leave at same time no matter what. If you start early you will be more successful. We hope the smaller organizations will move forward.

Resolve to Meet These Goals in 2013

 

Deb Grider, a certified documentation specialist for Blue and Associates, shared her top New Year’s resolutions with the Talk Ten Tuesday audience. Here is a sampling that providers will want to consider.

  • Conduct an impact assessment to get an “as is” state. Instead of just sending out a survey to get the answers you need, conduct interviews with key department staff.
  • Identify your risks and rank them by importance.
  • Build your training plan (include everything that will be touched by ICD-10, including, but not limited to, coding, system processes, workflow changes, practitioners, etc.).
  • Begin training practitioners, focusing on their specialties, and tell them what they need to document for their most commonly performed procedures.
  • Train coders early to build productivity and skill before the October 1, 2014, deadline.
  • Keep in touch with software vendors. Pin down their timelines and deadlines for testing.  Your motivation to do this is that revenue will be affected if claims aren’t submitted in a timely manner.
  • Assign a staff person to be responsible for keeping everyone on target, meeting implementation goals, etc.
  • Create a master plan of current status and where you need to be and when. Establish start dates and end dates, itemize tasks to accomplish, keep all channels of communication open.

“Every organization is unique, so needs will be different. Don’t risk your organization’s health by waiting,” Grider stated. “ICD-10 is closer than it seems: Get up and get going.”

Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.