July 10, 2012

With Every Breath

By

If you’re one of the eight people who reads my article each month, you may have concluded one or more of the following:

  • I’m cynical
  • I’m anti-CMS
  • I’m anti-ICD-10
  • I don’t know jack
  • All of the above, and more.

If you came to any of those conclusions, I would confess you are partially right, while declaring you largely wrong.

  • I’m cynical only in matters of politics and certain individuals I’ve known whom I shall not name. (“If you cannot say something nice about someone, say nothing.” – my mother)
  • I’m a person who holds the staff of CMS in high regard, because a) they always are helpful when I ask and b) they do some genuinely brilliant work. (Really READ the IPPS/LTCH Final Rule this year if you doubt me.)
  • I’m certain the selling of ICD-10 to us all includes some of the elements of a well-played confidence game… and it IS an election year.
  • The only things about which I write are things I know OR things on which I have an opinion… in other words, I write about exactly the same things everyone else does.

At this point, you’re probably thinking: “Why doesn’t he just get on with it and makes his point for this month?!” Here it is:

It is irrelevant whether anyone likes ICD-10. It’s the law.

It may be delayed, surely, but it’s still the law. After all, some parts of the PPACA are not in effect, but it’s still the law. You are not obligated to pay property tax until early next year, but it’s still the law. Frankly, there are LOTS of laws that don’t impress me much, but I still follow them, and I know you do, as well. (If you do not, we probably should put a sign on your back that says: “Misdemeanor Walking.”)

So, to manage the ICD-10 conversion process—whether it is fully implemented in 2013, 2014, or beyond—there is one overriding action we each must take:

We must accept the reality and do the work.

If you (or your supervisor or employer) resist ICD-10, all you’re doing is setting yourself up for failure. Consider this little fable:

  1. You work for Alpha Medical Center (AMC).
  2. Beta Community Hospital (BCH) across town shares your Medical Staff.
  3. Both hospitals are buying ICD-10 “encoder software” when the deadline draws near.
  4. Both hospitals are training their coders to do both ICD-9 and ICD-10 coding, because you can’t assume ICD-9 is EVER going away.
  5. But… BCH and all its employees are embracing ICD-10 as if it were the Holy Grail of Healthcare, while you at AMC are not. You’re doing the minimum necessary to keep filing claims after ICD-10 is law, and that’s the extent of it.

Well, guess what: That shared Medical Staff is picking up two very different moods at your two hospitals.

  • At BCH, they enjoy lots of support as they prepare their own ICD-10 conversions.
    • At your hospital, AMC, they don’t.
    • At BCH, everyone from Access to Nursing to the Clinical Ancillaries to the Support functions (like Dietary and Environmental Services) can “Walk the Walk and Talk the Talk,” at least to the extent it impacts their jobs.
      • At AMC, you can’t.
      • At BCH, they setup an EMR that’s integrated with HIM supporting both ICD-9 and ICD-10, and also can support the billing and record keeping in each physician’s office.
        • At AMC, you haven’t and you can’t.
        • At BCH, clean claims are going to go to payers as long as the hospital is open for business, and they’ll be paid in the timely manner to which they’ve become accustomed.
          • At your AMC, “denial” is destined to become the most common word in the PFS Manager’s vocabulary.

Any time there is a monumental change in any system, the inputs and outputs to the system must be realigned if the system is to continue functioning. That is, it must adjust to the environment. If you don’t embrace ICD-10—not tolerate it, but really EMBRACE it—then you are setting yourself and your organization up for failure. And that is unconscionable.

It’s very simple, really:

ICD-10 is law—or soon will be law—and with every breath you take you should be endorsing it, supporting it, proselytizing for it. You should be a vocal leader in its adoption; a mentor to those in your organization who still don’t “get it;” and a hero to your employer, your community, and your patients, all of whom are DEPENDING on you to do it right the first time. Anything less is failure.

Make a choice. Join the movement, or get out of the road.

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

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Read 8 times Updated on September 23, 2013
Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.