Top at risk drg s in the post icd 10 era and how to proactively address coding challenges webinar...
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Top at Risk DRG’s in the Post ICD-10 Era Sponsored by MiraMed Global Services How to Proactively Address Coding Challenges
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Transcript of Top at risk drg s in the post icd 10 era and how to proactively address coding challenges webinar...
Top at Risk DRG’s in the Post ICD-10 Era
Sponsored by MiraMed Global Services
How to Proactively
Address Coding Challenges
Sponsored by MiraMed Global Services
For more information contact:Phil C. Solomon
This webinar presentation has been shortened for the purposes of this SlideShare posting
Sponsored by MiraMed Global Services 3
For over 29 years Mr. Sornberger lead revenue cycle activities for The Cleveland
Clinic and UPMC and has consulted with the largest health systems in the country. He has
authored over 2,200 articles for HFMA, AAHAM, and other leading healthcare
publications and has been a featured speaker at over 125 healthcare revenue cycle
industry events.
Lyman G. SornbergerChief Strategy Officer - Capio Partners
President & CEO - LGS Healthcare Consulting
Presented by:
Sponsored by MiraMed Global Services 4
Learning ObjectivesThe importance of documentation and associated risk areas
Understand costs to rework claims – re: coding errors & cut your expenses
Track performance through executive & operational dashboards
Identify top KPI’s and benchmarks that you need to know
Create governance parameters for outsourcing with coding outsourcer
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How to pick the right coding outsourcing partner 6
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Sponsored by MiraMed Global Services
Polling Question
Question
How would you assess your systems readiness on October 1st?
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Mitigate Risk Your Post ICD-10 check-up from the neck-up Validate your financial
impact and cost Communicate and
chart your findings Training strategy & plan What are your strategies? Create a plan and preventative protocol
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Scope of Service Line
Education and Awareness - Leadership & Board
Impact Analysis – Financial/Performance/Risk Mitigation/Strategies
Implementation Strategy/Planning - Program Charter/Budget Estimates
Timeline & Dependencies
Readiness – Technology/Revenue Cycle/Clinical Documentation/People
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Total Budget $3.1M Capital $800K Patient Access $925K CDI $200K ($140K R) HIM $820K ($500K R) Training $400K ($250K R)
Example 300 Bed Hospital
$890K Recurring Cost
Financial Risk/Budget
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Providers overwhelmed discovering effort required for the ICD-10 transition
A data-driven approach helps providers conserve resources and limit compliance costs minimizing disruptions
ICD-10 Analytics
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Neuro Surgery
CardiologyOrthopedics
DRG’s At Risk
YesNo
Maybe
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External Exposure Vendor Readiness (C) Payer Readiness (C) Community Providers Coders
(CAC / NLP / Offshore Outsourcing)
Training Total Cost
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Dual Workflow
In-house Outsource
Partnership StrategyExpens
e Reducti
on
On/Off Shore
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Benefits and Risks Assess reimbursement shifts Coding Denials Contracting Engage providers in trends Assess revenue risk Promote strategies to mitigate risk Identify revenue maximization opportunities
14/7Ask for Handouts
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Fourth Quarter 2015 Assess Lessons Learned from Risk Mitigation Verify Revenue Impact Memorialize Future Training Seek Additional Improvement Opportunities:
Denial Management Coding CDI, CAC, NLP Automated Coding, etc.
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2016
Seek Additional Improvement Opportunities
Benchmark Peer Performance Verify Revenue Impact
Benchmark
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2017• Establish Performance Targets
• Verify Revenue Impact
• Seek Additional
Improvement Opportunities
• Manage Against Reimbursement Changes
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What to Continue Doing
Communicate
Monitor cash impact
Train, train, train
Identify problems/shift resources
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What to Begin Doing
Trending-peer to peer
Manage denial inventory
Monitor underpayments
Enhance training program
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Questions
Contact: Phil SolomonVice President Global ServicesMiraMed [email protected]
Do You Have Any Questions?
