PFS' Revenue Cycle Stabilization
...
a Defensive Stgrategy for ICD-10 & HIPAA 5010:
Industry
has been alerting the constituents to the ICD-10 and 5010 conversions about the impact that these two implementations will
have on provider revenue cycles. Below you will find excerpts from representative articles and presentations from among the
hundreds that can be found with a simple web search. Each of them includes the recommendation to establish a plan to mitigate
the financial impact that will result from these federally mandated projects.
Deloitte's Top 10 ICD-10 List
Posted on Fri, Mar 05, 2010 - 08:52 am
http://www.icd10watch.com/print/5796 7/9/2011
The ICD-10 “transformation in systems and processes is expected
to catalyze significant industry change and provide potential benefits,” including cost and quality measurement, public
health, research, as well as organizational monitoring and performance management, according to Christine Armstrong, a partner
at Deloitte who penned the firm's list, 10 things to know about ICD-10 implementation. Here's the boiled-down version:
1. ICD-10 will require a massive overhaul of
the U.S. medical coding system.
2. Providers should conduct a three-pronged assessment that looks at the financial,
operational, and technology aspects – and do so in the short-term.
3. The ICD-10 Conversion
will affect all areas of the revenue cycle, not just coding.
4. Hospitals will have to upgrade multiple
IT systems to support ICD-10.
5. Physician practices face both financial and operational burdens from ICD-10 and associated
technology requirements.
6.
Expect productivity reductions, most of all in functional areas that currently use ICD-9 codes.
7.
Be prepared to run dual systems during the transition.
8. ICD-10 will demand significant technology
changes from providers ecosystems, including IT vendors, trading partners, external reporting entities and payers.
9.
New diagnosis and procedure codes will bring security and privacy issues.
10. Medical staff, nurses, and allied health providers will all need
to be trained on the new clinical documentation and coding nomenclature.
United Healthcare (Quote from a publication
targeting Providers)
Ross
Lippincott, Vice President 5010 & ICD-10 Programs
The ICD-10 Playbook: Hitting IT Out of the Park!Posted on May 26, 2011 by John Casillas:
“Ross
Lippincott, Vice President 5010 & ICD-10 Programs, United Healthcare, then focused on the newly released HIMSS G7 Advisory
Report … Lippincott suggested that there could be a “5-year stabilization period” after ICD-10 implementation.
Thus, there is a critical need to mitigate financial risks. He echoed McDowell’s comments that a financial baseline
is required, establishing a bridge plan with a bank, reserving 6 months of cash flow and develop contingency plans,
if drops in revenue occur.”
Milliman (White
Paper targeting Health Plans)
Patricia
Zenner, Lisa Mattie and Kathy Zaharias
http://publications.milliman.com/publications/health-published/pdfs/ten-critical-factors-health.pdf
“… the
increased specificity of ICD-10 will inevitably modify processes related to code edits, precertification requirements, benefit
coverage, and medical necessity policy. These modifications will not only affect productivity, but provider reimbursement
as well”. “Ten Critical Factors for Health Plan Success in Implementing ICD-10”:
1.
Build a strong implementation foundation.
2.
Implement an organized change plan.
3.
Train and educate: deliver the right message, to the right people, at the right time.
4. Ensure effective communications.
5. Optimize use of available tools.
6. Understand,
mitigate, and plan for the financial impact.
7.
Manage vendor relationships.
8.
Manage provider relationships.
9. Integrate and coordinate with other priorities
and initiatives.
10. Develop strategic opportunities.
Top Tier Consulting (Presentation)
ICD-10 Primer, Jon Melling – President,
AzHeC Western States Summit, April 12, 2011
“Revenue Cycle performance will likely experience:
Increase in unbilled receivables
Increase in accounts receivables
Slowed and
/ or reduced cash flow”
Dell Services, Healthcare Consulting (Presentation)
Wendy Haas, MBA, RN, Dell Services, Healthcare Consulting
“ICD-10 Operational and Revenue Cycle Impacts”
http://www.google.com/search?q=Dell+%22ICD-10+Operational+and+Revenue+Cycle+Impacts%22&hl=en&rlz=1R2ADFA_enUS425&biw=1440&bih=689&num=10&lr=&ft=i&cr=&safe=images&tbs=
Plan to mitigate
increased A/R due to increased denials Plan to mitigate reduced reimbursement due to documentation
deficiencies”.
McKesson
(White Paper)
“A McKesson Perspective: ICD-10-CM/PCS”
http://www.strategiestoperform.com/volume4_issue9/docs/091MPT_ICD_10_WHT340_21028.pdf
Project the Impact to
Cash Flow: Develop a cash management strategy to ensure you have enough cash on hand to cover the transition period.
During the transition, plan for a higher percentage of rejected claims due to inadequate documentation or inappropriate
coding.
Robert
E. Nolan Company
(Presentation)
Prepared For: Blue Cross and Blue Shield Association:
“Coding backlogs
are likely to slow payment to providers creating enormous cash flow problems and gaps in data for payers. The consequences
of such a slow down are increased inquiries among all parties, including patients, providers and health plan members,
short term borrowing costs and potential under and over payments.”
Take Action Now: PFS calculates the maximum advance cash values from a historical analysis of a practice’s
billing and collection history. The time to have PFS evaluate your practice is now …
before there is any erosion to revenue cycle performance following the implementation of ICD-10 and 5010. Partnering
with PFS for your revenue cycle stabilization strategy now will assure that your practice will be able to sustain the impact
of ICD-10 and 5010 with stabilized cash flows based on yesterday …
not tomorrow.
