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?

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?

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.

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

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.

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

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.

CMS: RACs to Conduct Prepayment Demonstration Project

By: Barbara Aubry

On November 15, 2011, CMS has announced it intends to have RACs, MACs and CERTS conduct prepayment reviews in states with “historically high rates of improper payments” based on prior audits.  In this category, seven states have been selected for the demonstration: FL, CA, MI, TX, NY, LA and IL. Four states with high volumes of claims for short inpatient stays are also included in the demonstration: PA, OH, NC and MO; adding up to eleven states in total. According to CMS, the goal is to “help lower the error rate by preventing improper payments rather than the traditional ‘pay and chase’ methods of looking for improper payments after they have been made.” The demonstration begins January 1, 2012, and is expected to last for three years.  The project has two areas of focus: the eventual preauthorization of certain DME (temporarily on hold – click here for more) and the second is the ability for hospitals to resubmit claims for 90 percent of Part B charges on an inappropriate short stay.

ICD-10 Basics: Achieving Accurate Reimbursement

By: Ann Frischkorn Chenoweth

As providers shift from using ICD-9 to ICD-10, there will be benefits in the form of more accurate payments for new procedures, fewer rejected claims, fewer improper reimbursement claims and greater efficiency in the billing and reimbursement process.

ICD-10’s improved precision in documentation of clinical care will greatly improve the likelihood of submitting accurate claims the first time around and receiving appropriate reimbursement.

The increased granularity of ICD-10 code will help reduce the number of claims being investigated or rejected due to insufficient information.  ICD-10 will solve the problems caused due to lack of detailed information contained in the diagnosis and procedure code assignment.  Fewer rejected claims will reduce the amount of rework for providers leading to an efficient reimbursement process which in turn reduce negative impacts to your revenue cycle.

Putting the “Accountable” into Accountable Care

By: Sandeep Wadhwa

The talk about Accountable Care is turning into action with the announcement of the Pioneer ACO awardees from CMS.  In addition, the Medicare Shared Savings Program solicitation has been released with initial responses now being accepted.  As delivery systems and providers consider whether they want to respond, I’d like to suggest some key areas to consider.