The Time to Prepare is Now: Revamp Your Revenue Cycle for ICD-10
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Transcript of The Time to Prepare is Now: Revamp Your Revenue Cycle for ICD-10
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Jim Yarsinsky, CRCE-1President and Founder, ExpeditiveAccompanied byLuis Nicot, MBARevenue Cycle Consultant
The Time to Prepare is Now:Revamp Your Revenue Cycle for ICD-10
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Meet Expeditive’s Jim Yarsinsky
• Certified Revenue Cycle Executive (CRCE-1)
• 30+ years in healthcare revenue cycle
• Founded Expeditive, an interim staffing and consulting firm to address need for interim staff with healthcare-specific experience
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Meet Luis Nicot, MBA• Managing Partner of TrueNorth
Consulting Group, Inc.• 25+ years as an educator and
revenue cycle consultant• Earned his MBA in Healthcare
Administration
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What you will learn• What ICD-10 implementation means for you• How to prepare your hospital• Your options for tackling implementation
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ICD – 10 is coming !Expect a nightmare!
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“Plans are nothing, planning is everything”
– Dwight D. Eisenhower
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What processes will be impacted by ICD-10?
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Impact to processesNurse
sPhysicia
nsClinical Lab
• Forms• Documentat
ion• Prior
Authorization
• Documentation
• Code Training
• Patient Coverage
• Superbills• ABNs
• Documentation
• Reporting
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Impact to processesManag
ersBilling Coding Front
Desk
• New Policies and Procedures
• Vendor and Payer Contracts
• Budgets• Training
Plan
• Policies and Procedures
• Training
• Code Set• Clinical
Knowledge• Concurrent
Use
• HIPPA• System
s
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How to become…
ClinicalTechnology
Financial Expeditive
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(About 30 - 60 Days Duration)
Create an ICD-10 Assessment Process
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Have a formal denial management
system in place
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Denial Checklist• Define first area of focus.
• Analyze where and why denials occur.
• Improve denial and recovery rate jointly.
• Define how to sustain the improvements.
• Create Denial Task Force.
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Denial Goals• Benchmark: Best Practice KPI target = 4% gross
revenue
– Determine what is achievable at the onset.
– Define a realistic timeline towards best practice
• Where does your facility stand?
– What are your avg monthly denied dollars in comparison to other like facilities? Clearinghouse may have the answer.
– What are your billing (277) rejections?
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Root Cause Denial AnalyticsWhat is the root cause?
– Isolating denials by user ID to identify user competency (80-20)
– Eligibility tool problem– Flawed scrubber edits– Clinicals not faxed– Auth numbers not extended to discharge– Late admission notification– Auth number too long for field length
Denial management programs can only succeed as long as providers place action and accountability at the point of service that triggered the denied
claim.
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Have 3-6 months of cash on hand
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How do I get 3-6 months of extra cash?
• Start TODAY• Amp up your billing• Increase POS collections• Accelerate high balance
account collections• Evaluate AR outsourcing
options
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• Billers• Coders• Frontline
staff• Doctors • Nurses• Management
Have representatives from every part of the revenue cycle!
Assemble your ICD-10 implementation team
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Make sure your team hasenough horsepower (and data)!
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How can we sustain improvements?– Streamline follow-up activity – Auto appeal templates– Write off threshold authorization levels– Exception based follow-up– Track follow-up cash performance– Work 277 Rejections– Configure all 277 data into workflow
logic (good and bad) 277 transactions.
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Trending Amount by ReasonFOR DATES RECEIVED 08/01/2013 THROUGH 02/28/2014
Description Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Total Average
Duplicates $708,003 $986,927 $737,302 $1,272,598 $1,853,763 $914,854 $887,646 $7,361,094 $1,051,585
Non-covered Service $842,984 $897,357 $749,170 $515,236 $452,662 $1,107,893 $1,167,530 $5,732,832 $818,976
Documentation $659,998 $775,933 $1,183,854 $825,615 $926,239 $750,220 $485,953 $5,607,812 $801,116
Bill - Data Quality $559,776 $1,450,140 $507,726 $190,412 $1,251,572 $193,642 $203,797 $4,357,065 $622,438
Coordination of Benefits $513,464 $491,128 $350,987 $445,983 $475,202 $503,934 $445,805 $3,226,504 $460,929
Medical Necessity $484,880 $627,961 $682,049 $487,961 $411,590 $230,683 $101,856 $3,026,980 $432,426
Eligibility $505,730 $348,864 $422,245 $412,462 $321,368 $365,521 $496,364 $2,872,553 $410,365
Authorization $197,989 $452,906 $312,862 $302,926 $185,815 $308,121 $161,826 $1,922,445 $274,635
Exhausted/Expired Benefits $567,610 $199,764 $95,435 $187,063 $273,087 $180,887 $387,379 $1,891,225 $270,175
Reduction $301,880 $308,609 $151,869 $161,754 $303,996 $422,956 $210,312 $1,861,376 $265,911
Untimely Filing $205,018 $145,368 $437,008 $341,635 $142,657 $58,015 $394,482 $1,724,183 $246,312
Coding $78,525 $67,997 $324,328 $122,663 $78,901 $52,390 $157,479 $882,283 $126,040
Pending $25,776 $48,456 $11,953 $155,230 $10,509 $91,912 $19,734 $363,570 $51,939
Review $31,519 $64,232 $94,808 $544 $72 $1,540 $192,716 $27,531
Experimental $24,377 $7,564 $32,149 $25,223 $50,685 $12,927 $5,246 $158,171 $22,596
Registration $16,335 $7,525 $10,190 $49,960 $29,926 $9,635 $21,056 $144,627 $20,661
Charge Data Master ($1,441) $141 $8,551 $6,516 $12,074 $15,260 $43,978 $85,080 $12,154
Total $5,722,423 $6,880,874 $6,112,487 $5,503,781 $6,780,116 $5,220,391 $5,190,444 $41,410,516 $5,915,788
Trending Reports (dollars) provide historical views and isolate real problem areas.
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Getting Help: What are your options?
It’s okay if you need help.
• Hiring full time staff• Outsourcing• Interim staffing & consulting
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• Nation’s leading provider of interim staffing and consulting for the healthcare revenue cycle
• Addresses revenue cycle problems by dispatching qualified staff to healthcare facilities
• Works with facilities ranging from large health systems to rural critical access hospitals
Meet Expeditive
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How Expeditive can help
• A/R SWAT Teams• Denial SWAT Teams• All staff members have 13+ years of
healthcare-specific revenue cycle experience
• Onsite within 48 hours
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Want more information?For revenue cycle updates, tips, and tricks…
Connect with Jim and Expeditive on social media!
@Expeditive/in/jimyarsinsky/ExpeditiveLLC/+ExpeditiveLLC