Author: Jill Berger-Fiffy , MHA, FACMPE
The planning and implementation of the ICD-10 felt much like a race to the finish. Now in operational mode, it is helpful to begin your “After Action Review” in order to identify potential next steps. The following will help you craft your “to do list” when managing the revenue cycle.
- Cash flow-Regardless of whether you submit your claims through a clearinghouse or directly to the payer, be sure to reconcile that every claim reaches the clearinghouse and/or payer. Delays in payment may be the new reality. Develop a plan as to when and how you will begin to use your line of credit should you have one. Consider the need to reduce or hold the salaries and reimbursements to physician owners.
- Expense Management-Organize your payables and hold them for as long as possible. Transition from writing checks to the use of bank transfers which can be set up in advance. This allows the practice to hold the cash as long as possible but expedite your payment by the “due date.”
- Flexible Staffing-Consider the need for temporary staff to review claims and/or work the Accounts Receivable (AR). Productivity for physicians and staff is likely to decrease, thus increasing the overall cost to do the same work. This may be reflected in increased patient wait time and decreased patient satisfaction. If this is the case, workflow verification, analysis and optimization will be essential to ensure the work is completed efficiently.
- Risk Sharing-Consider the staffing compliment in the practice. Does the practice have the right staff/enough staff to support the effort required under the new payment schemes and the ICD-10 world? If you have Certified Coders, prioritize the work to be completed. Ensure Coders are focusing on the “big ticket” items; as well as, those diagnosis categories in which the practice may be at financial risk or in a cost sharing with an ACO reporting effort.
- Auditing-When auditing medical records, show the physician how the requirements and clinical documentation differ from the ICD-9 to ICD-10. Be aware of the pitfalls of provider documentation. Ensure notes comprise the highest level of specificity and match the diagnosis code selected. Another pitfalls can include the note not capturing the level of specificity reflected in the code or the documentation being very specific and non-specific code is selected. Auditing and compliance review will be crucial in an environment in which specificity, quality, cost and efficiency are all factors.
- Key Performance Indicators– Watch the metrics closely. Carefully monitor changes. Alert your team about potential changes such as increased Denial rate with the clearinghouse and from the payer, percentage of 1st Pass Submission, Days in A/R, Charge Lag, Collection Rate, and Net Revenue per FTE Physician. Compare past performance by the month to date and to the year over year. Monitor trends by building a dashboard with key measures. Consider using software to assist with denial analysis and analytics in order to maximize revenues.
- Quality Metrics– It is likely the practice is involved in at least one pay for performance program. Given the many such as Meaningful Use, PQRS, Value Based Modifier, and HEDIS Measures to name a few. You may need to manipulate your data to compare a prior period to the new “current state”. Data manipulation and business intelligence tools will track progress of the practice and provide “actionable” steps. Look for opportunities to improve patient care through workflow redesign.
- Technology-Ensure the practice is optimizing all of the features of the Electronic Health Record. Confirm the templates and their associated diagnosis codes are updated. Verify departmental and individual lists of “favorites” been updated and are they shared across the department. Review questionnaires, encounter forms, order sets, referral and authorization forms, pick lists for diagnosis used to populate for surgical scheduling forms and of course admissions and discharges. Consider the process for communicating changes and if additional training is now needed. IT staff will need to understand the needs of the end user and be able to “build” the system to meet the requirements.
- Software-Review the edits/rules in your Electronic Health Record, are they up to date? Adding coding tools can be helpful, but many times it can lead to the selection of a “non-specific code” which would ultimately be rejected by the payer. Educate staff on how to use the system and when they should refer to the coding book?
- Interfaces-Are you using devices or other have programs which interface with your system? If so, has the interface been tested and updated? Confirm if the manufacturer has offered an update version?
In summary, the go live date has passed, but the work has just begun. It will take a multi-faceted approach to remain solvent in this new revenue environment.