Category Archives: Revenue Cycle

The Impact of ICD-10 on Reimbursement: What’s Realistic?

HFMA Reg 2On a beautiful fall day in upstate New York, I joined a group of healthcare financial executives at the HFMA Region 2 Fall Institute. Meeting hot topics included change management, the CMS Two Midnight rule, big data, and Medicaid updates.

Attendees also learned about the impact of ICD-10 on reimbursement in my presentation “ICD-10: Determining the Realistic Reimbursement Impact on MS-DRGs and APR DRGs.” While ICD-10 may impact many areas of the revenue cycle after October 1, 2015, including the DNFB and cash flow, my presentation focused on analyzing the potential shift in reimbursement by comparing claims coded in ICD-9 and ICD-10. Continue reading

Will 2014 be a Year to Remember for Outpatient CDI?

The other day, I was thinking back to the year 1987: Ronald Reagan was President, the New York Giants won the Super Bowl and the Minnesota Twins won the World Series. Michael Jackson released his third album, Bad, and “Walk Like an Egyptian” by the Bangles was the number one hit on The Billboard Top 100.

1987 was also the beginning of an important initiative in healthcare and health information management. This was the year that 3M created its inpatient clinical documentation improvement (CDI) program. Continue reading

ICD-10 Revenue Retention: Is There a Magic Wand?

Guest blog by Charlie Bernstein

Every healthcare organization in the country has the same question: What will ICD-10’s impact really be? And every time I speak with 3M clients, I know they are hoping to hear about a secret magic wand that will seamlessly handle ICD-10. Voila!

Does this magic wand exist? I hate to break it to you but…no. But don’t despair. There are tools and methods to take the sting away. Beyond the initial conversions, much consternation is focused on reimbursement, as in:

  • How will ICD-10 affect my revenue?
  • How do we measure the impact?
  • How much are we going to lose in 2014 because of ICD-10?
  • Which departments are affected most? Continue reading

Return on Investment: Evaluating Business Stability and Growth

Some of the less obvious ROI indicators are related to organizational strategy and work environment.  Below are some areas that you can investigate and potentially highlight as contributors to organizational growth and stability over time.  Each category contains some sample questions that you can explore by looking at past, present and desired future status of your organization and its staff.

Employee retention:  Is your staff satisfied with the communication and training they receive?  Do they feel that they get adequate IT and management support?  Are they comfortable using the new technology?  Are employees likely to stay with the organization or not, and why?

Continue reading

Return on Investment: Evaluating Production and Workflow Improvements

Some of the most practical ROI indicators are related to the productivity and efficiency of your work processes.  Here are some areas that you can investigate and potentially highlight as contributors to success.  Each category contains some sample questions that you can explore by looking at past, present and desired future performance in your organization, especially if you experienced any major changes, such as a new technology implementation, along the way.

PRODUCTION IMPROVEMENTS

Increased productivity:  Has your total volume of output increased?  Are you able to do more with the same amount or fewer staff?  Has your backlog been reduced or eliminated? Continue reading

Return on Investment: Was It Worth It?

Day-to-day life gives us lots of reasons to ask, “Why?” Why do we make the choices that we make? It’s a very important question. On a personal level, it helps us to determine if our decisions are moving our lives in the desired direction. On a professional level, it helps us determine if our organization is making decisions that are yielding good results.

But many times we jump into a change process without questioning how we will know if we are getting the results we want. That’s why the planning process is so important. Sometimes it’s true that you have to take a leap of faith when it comes to return on investment, but you can make an educated leap instead of a reckless one.

When an organization is considering a technology project, they usually focus their projections on how much profit could be made or how much cost savings could be incurred, and rightfully so. In health information management (HIM) organizations, this usually translates to improvement in productivity and turnaround times. But return on investment could also be assessed in other ways, such as streamlining the workflow or improving the skills or satisfaction of the workforce. Continue reading

CMS: New Improper Payment Edits Coming July 1, 2012

Recently, CMS released Transmittals 1051, Change Request 7661 (replacing Transmittal 1033) titled “Analysis of Improper Overpayments to Design Edits to Correct These Overpayments in CWF, MCS and FISS.” The new edits are the result of “significant improper payments and require the development of edits to correct improper payments” as discovered by – you guessed it – the OIG and RAC. No one is immune; the new edits will target physician place of service codes, E/Ms during the global period and hospital transfers among others. CMS is implementing edits for all claim types to recover payments.

For more, go to: http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1051OTN-.pdf Continue reading

ICD-10 Benefits: Research

ICD-10’s finer detail, and the fact that the cleaner logic of the codes may lead to fewer coding errors in the long term, cannot help but improve research.

If you look at the overall cost of medical care, a lot of the arguments are not that we’re spending too much, but that we’re spending it in a blind fashion. We’re spending money inappropriately. The ability to target our spending money and to try to get the money that we do spend to the places that it’s needed requires a higher level of that spending analysis than we can currently do with ICD-9. Continue reading

CMS Says: Do Yourself a Favor – Return the Overpayment

On Valentine’s Day, CMS sent a love note to the industry in the guise of a proposal, informing it of  the need to report and return self-identified overpayments  within 60 days of the incorrect payment identification or “on the date when a corresponding cost report is due, whichever is later.”

Twice before, in 1998 and 2002, CMS tried to enact changes to the amendment regulating recoupment of overpayments. The Health Care Education Reconciliation Act of 2010 (Pub.L.111-152) amended provision of Pub. L. 111-148 (Patient Protection and Affordable Care Act) to demand that providers and suppliers return any overpayments within the time frame stipulated above. Plus, the provider/supplier must inform the CMS in writing of the reason for the overpayment. In addition to providers and suppliers, this stipulation applies to Managed Care Organizations, Medicare Advantage Organizations, and Part D Plan sponsors, but not beneficiaries. Initially, the regulations will be amended to affect Part A and B providers and suppliers.  For more see http://s3.amazonaws.com/public-inspection.federalregister.gov/2012-03642.pdf Continue reading

ICD-10 for Busy Doctors

By: Rhonda Butler

This is the first in what I hope will be a useful series of blogs on the subject of ICD-10. Building on a previous blog, my goal is to offer clear, concise information about ICD-10 to physicians and physician practice managers, so they can focus on the key differences between the code sets—differences that actually matter for coding and documentation.

Basically, ICD-10 is a long overdue upgrade. ICD-9 is old as the hills and needs to be replaced. The ICD-9 classification contains notions of disease and treatment from the 1960s that don’t do any of us any good — the antiquated content of ICD-9 means physicians have to spend time answering questions about clinical language that hasn’t been used in a generation or more. If you would like more on this subject, see an earlier blog, “ICD is a System and Systems are Upgraded.”

Initial focus will highlight some general differences between ICD-9 and ICD-10 — not the ones that make for good yellow journalism, like the number of ICD-10 codes for getting bitten by various animals, but differences in clinical  terminology that are interesting from the point of view of good coding and documentation.

Read my latest blog at PhysBizTech.

Rhonda Butler is a Senior Clinical Research Analyst with 3M Health Information Systems.