September 24, 2013

ICD-10 After Midnight: Avoid Sleepless Nights by Focusing on Systems Integration

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As a result of the upcoming ICD-10 transition, many chief financial officers (CFOs) aren’t sleeping so well as they ponder the single biggest “what if” scenario: cash flow.

Speaking during the Sept. 17 broadcast of “Talk-Ten-Tuesday,” former hospital CFO and former Healthcare Financial Management Association (HFMA) chair Greg Adams—now president of the consulting services division of Panacea Healthcare Solutions—posed several “what if” questions that he says are keeping hospital leaders up at night.

 

Adams reported that the single biggest “what if” question on a CFO’s mind today is this: What if cash flow is impacted due to a lack of system integration?

Others include:

  • What if physician practice systems aren’t ready for ICD-10?
  • What if physician coding isn’t consistent with hospital coding?
  • What if value-based payments are lost due to inconsistent coding among providers?
  • What if inaccurate coding impacts quality scores and results in lost payer contracts and lower revenue?
  • What if payers aren’t prepared?

Some of these questions may not be answered until closer to the October 1, 2014, implementation date. But, according to Adams, CFOs are taking proactive steps toward answering the single-biggest question. Rather than sit around and worry about whether cash flow will be impacted, “They are taking steps by negotiating with payers for cash advances and increasing their lines of credit,” he says.

Although cash-flow concerns may be at the top of CFO list, there also are concerns about the changes needed to convert to ICD-10, which include a hospital’s core systems (health information management [HIM], patient financial services, utilization management, and quality measures). Since each of these systems passes information to the other, changes must be made on both an individual basis and in an integrated fashion—“a monumental task” as far as Adams is concerned.

In addition, “This becomes much more complex as we move into the era of bundled payments, physician integration and ACO [accountable care organizations] development,” Adams said. “Not only are we dealing with the most significant coding changes ever, but at the same time there are multiple providers and platforms that need to be prepared for these changes.”

The next point is what he calls “the kicker.” With the evolution to an integrated care model, hospitals must be concerned with the new parts of their own healthcare systems and recognize that they are no longer the only part. Additional cogs in the wheel may, for example, include physician practices, freestanding clinics, ambulatory centers, and home-health agencies. These previously independent entities must be made part of the integrated system.

If internal information technology (IT) systems are not interfaced properly, billings can be delayed, reducing cash flow. If external systems (claims scrubbers, billing vendors, etc.) are not prepared, billings will be delayed. If payers are not prepared, payment for claims will be delayed.

“As the saying goes, you’re only as strong as the weakest link,” said Adams. “Failure with any system can have serious repercussions.”

Other subjects Adams will address in the six-part series include the following:

Organizational education: Primary (coders), secondary (registrars), tertiary (billers), user employees, independent practitioners, ACO partners.

Value-based payments: Bundled payments, shared savings, capitation, etc.

Quality and clinical outcomes: Measuring quality improvements under different coding systems.

Healthcare analytics: Validity and consistency of data, data management, population health, etc.

Evolution of care model: Shift from IP to OP and preventative care, along with the coding implications for OP care.

Adams said these problematic areas must be addressed before the stroke of midnight on Sept. 30, 2014.

 

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.