Download - Survival in 2012 and Beyond
Survival in 2012 and BeyondLynne P. Byrd Lynne P. Byrd
V.P. of Revenue Cycle, Archbold Medical Center
• ● IdentifyIdentify practical operation • strategies for survival.
• ● RecognizeRecognize pilots and specific • programs that have yielded• positive operation results.
• ● CompareCompare operation perspectives • from 4 hospital systems.
LEARNING OUTCOMES OF PRESENTATION
.
Value Based Purchasing Performance = Reimbursement
Key Areas of Focus for Revenue Cycle
5010 and ICD-10 Conversion Do you have a plan?
Clinical Documentation Improvement Physician Education & Computer-Assisted coding
Career Ladders - Education is Key!! Staff development is essential to survival
Denials Management Establish an effective process now
Managed Care Contract Compliance Validate your reimbursement
• ●Eligibility – 270/271• Improved transactions• Improved COB
• ●Electronic Claims - 837• ●Claims Status – 276/277• ●Authorizations - 278• ●Remittance Posting - 835• ●Know what your key payers are doing
Key Transactions to validate and test by payer
5010 Conversion
• HIM Preparation• - Coder Education
plan early and provide LOTS!
• - Staffing and Productivity
• *Recruit now• *Augment with
Computer-assisted coding tools
• Clinical Documentation Improvement
• - Concurrent coding @ bedside
• - Improve physician documentation
• - Dedicated staff
• Cash Flow Protection
• - Reduce DNFC• - Reduce DNFB• - Reduce AR
days• - Clean up
denials• NOW• To make room for
the back log!
ICD-10 ConsiderationsWhat you need to be doing now……..
• ●Concurrent coding of the patient record at the bedside
• ●Clinical Documentation Specialist (CDS) RNs will work with physicians to complete the documentation needed in the patient’s record for final coding during the stay
• ●Medical Records staff will perform final coding• ●Overall goal is ACCURACY of clinical record; and Improved QUALITY reporting → SOI and ROM index
• ●Documentation translates into proper reimbursement for care delivered
Essential program for ICD-10 success
Clinical Documentation Improvement
• CMS will withhold a percentage of reimbursement (excluding critical access hospitals) beginning with 1% in fiscal year 2013 and ramping up to 2% by 2017.
• They will then redistribute those dollars as incentive payments based on performance.
• 1st Baseline Period complete: July 1, 2009 – March 31, 2010
• 1st Performance Period: July 1, 2011 – March 31, 2012
• 2 Domains for now : • Clinical Process (70% weight) & Patient
Experience (30%)
• 3 on the way: Mortality, Hospital-acquired Conditions, Patient Safety
Reimbursement Impacted by PerformanceValue-Based Purchasing
Value-Based Purchasing
PATIENT ACCESS
• Driven by training and certifications
• 5 levels:• Level 1 – HTH Pt Access
Cert• Level 2 – HTH Pt Access
Spec• Level 3 – HFMA CFC• Level 4 – HFMA CPAR• Level 5 – HFMA ACPAR
• Driven by experience, training, and certifications
• 5 levels: (under development)
• Level 1 – HTH Business office
• Level 2 – HFMA CPAR• Level 3 and 4 -
• HFMA CFC/ACPAR depending on job code
•
PATIENT FINANCIAL SERVICES
Career LaddersStaff development is a primary key to success
• ICD-10: estimates of • 10-25% increase in government initial denials
• Imperative to have effective process in place now as pace will be accelerating
• Technical Denials are increasing from all payers
Denials ManagementThis is not new, but more important than ever……
Validate your reimbursement
Check for “silent PPO” activity
Check for unauthorized discounts taken by contracted payers
Watch for 3rd party “Re-pricers” being employed by self-insured companies
Validate Managed Care paymentsAre your claims being re-priced by a non-
contracted 3rd party?
• ● IdentifyIdentify practical operation • strategies for survival.
• ● RecognizeRecognize pilots and specific • programs that have yielded• positive operation results.
• ● CompareCompare operation perspectives • from 4 hospital systems.
LEARNING OUTCOMES OF PRESENTATION
.
QUESTIONS?Lynne ByrdVP, Revenue ManagementArchbold Medical Center
[email protected]@archbold.org