The Time to Prepare is Now: Revamp Your Revenue Cycle for ICD-10

Jim Yarsinsky, CRCE-1President and Founder, ExpeditiveAccompanied byLuis Nicot, MBARevenue Cycle Consultant

The Time to Prepare is Now:Revamp Your Revenue Cycle for ICD-10

Meet Expeditive’s Jim Yarsinsky

• Certified Revenue Cycle Executive (CRCE-1)

• 30+ years in healthcare revenue cycle

• Founded Expeditive, an interim staffing and consulting firm to address need for interim staff with healthcare-specific experience

Meet Luis Nicot, MBA• Managing Partner of TrueNorth

Consulting Group, Inc.• 25+ years as an educator and

revenue cycle consultant• Earned his MBA in Healthcare

Administration

What you will learn• What ICD-10 implementation means for you• How to prepare your hospital• Your options for tackling implementation

ICD – 10 is coming !Expect a nightmare!

“Plans are nothing, planning is everything”

– Dwight D. Eisenhower

What processes will be impacted by ICD-10?

Impact to processesNurse

sPhysicia

nsClinical Lab

• Forms• Documentat

ion• Prior

Authorization

• Documentation

• Code Training

• Patient Coverage

• Superbills• ABNs

• Documentation

• Reporting

Impact to processesManag

ersBilling Coding Front

Desk

• New Policies and Procedures

• Vendor and Payer Contracts

• Budgets• Training

Plan

• Policies and Procedures

• Training

• Code Set• Clinical

Knowledge• Concurrent

Use

• HIPPA• System

s

How to become…

ClinicalTechnology

Financial Expeditive

(About 30 - 60 Days Duration)

Create an ICD-10 Assessment Process

Have a formal denial management

system in place

Denial Checklist• Define first area of focus.

• Analyze where and why denials occur.

• Improve denial and recovery rate jointly.

• Define how to sustain the improvements.

• Create Denial Task Force.

Denial Goals• Benchmark: Best Practice KPI target = 4% gross

revenue

– Determine what is achievable at the onset.

– Define a realistic timeline towards best practice

• Where does your facility stand?

– What are your avg monthly denied dollars in comparison to other like facilities? Clearinghouse may have the answer.

– What are your billing (277) rejections?

Root Cause Denial AnalyticsWhat is the root cause?

– Isolating denials by user ID to identify user competency (80-20)

– Eligibility tool problem– Flawed scrubber edits– Clinicals not faxed– Auth numbers not extended to discharge– Late admission notification– Auth number too long for field length

Denial management programs can only succeed as long as providers place action and accountability at the point of service that triggered the denied

claim.

Have 3-6 months of cash on hand

How do I get 3-6 months of extra cash?

• Start TODAY• Amp up your billing• Increase POS collections• Accelerate high balance

account collections• Evaluate AR outsourcing

options

• Billers• Coders• Frontline

staff• Doctors • Nurses• Management

Have representatives from every part of the revenue cycle!

Assemble your ICD-10 implementation team

Make sure your team hasenough horsepower (and data)!

How can we sustain improvements?– Streamline follow-up activity – Auto appeal templates– Write off threshold authorization levels– Exception based follow-up– Track follow-up cash performance– Work 277 Rejections– Configure all 277 data into workflow

logic (good and bad) 277 transactions.

Trending Amount by ReasonFOR DATES RECEIVED 08/01/2013 THROUGH 02/28/2014

Description Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Total Average

Duplicates $708,003 $986,927 $737,302 $1,272,598 $1,853,763 $914,854 $887,646 $7,361,094 $1,051,585

Non-covered Service $842,984 $897,357 $749,170 $515,236 $452,662 $1,107,893 $1,167,530 $5,732,832 $818,976

Documentation $659,998 $775,933 $1,183,854 $825,615 $926,239 $750,220 $485,953 $5,607,812 $801,116

Bill - Data Quality $559,776 $1,450,140 $507,726 $190,412 $1,251,572 $193,642 $203,797 $4,357,065 $622,438

Coordination of Benefits $513,464 $491,128 $350,987 $445,983 $475,202 $503,934 $445,805 $3,226,504 $460,929

Medical Necessity $484,880 $627,961 $682,049 $487,961 $411,590 $230,683 $101,856 $3,026,980 $432,426

Eligibility $505,730 $348,864 $422,245 $412,462 $321,368 $365,521 $496,364 $2,872,553 $410,365

Authorization $197,989 $452,906 $312,862 $302,926 $185,815 $308,121 $161,826 $1,922,445 $274,635

Exhausted/Expired Benefits $567,610 $199,764 $95,435 $187,063 $273,087 $180,887 $387,379 $1,891,225 $270,175

Reduction $301,880 $308,609 $151,869 $161,754 $303,996 $422,956 $210,312 $1,861,376 $265,911

Untimely Filing $205,018 $145,368 $437,008 $341,635 $142,657 $58,015 $394,482 $1,724,183 $246,312

Coding $78,525 $67,997 $324,328 $122,663 $78,901 $52,390 $157,479 $882,283 $126,040

Pending $25,776 $48,456 $11,953 $155,230 $10,509 $91,912 $19,734 $363,570 $51,939

Review $31,519 $64,232 $94,808 $544 $72 $1,540 $192,716 $27,531

Experimental $24,377 $7,564 $32,149 $25,223 $50,685 $12,927 $5,246 $158,171 $22,596

Registration $16,335 $7,525 $10,190 $49,960 $29,926 $9,635 $21,056 $144,627 $20,661

Charge Data Master ($1,441) $141 $8,551 $6,516 $12,074 $15,260 $43,978 $85,080 $12,154

Total $5,722,423 $6,880,874 $6,112,487 $5,503,781 $6,780,116 $5,220,391 $5,190,444 $41,410,516 $5,915,788

Trending Reports (dollars) provide historical views and isolate real problem areas.

Getting Help: What are your options?

It’s okay if you need help.

• Hiring full time staff• Outsourcing• Interim staffing & consulting

• Nation’s leading provider of interim staffing and consulting for the healthcare revenue cycle

• Addresses revenue cycle problems by dispatching qualified staff to healthcare facilities

• Works with facilities ranging from large health systems to rural critical access hospitals

Meet Expeditive

How Expeditive can help

• A/R SWAT Teams• Denial SWAT Teams• All staff members have 13+ years of

healthcare-specific revenue cycle experience

• Onsite within 48 hours

Want more information?For revenue cycle updates, tips, and tricks…

Connect with Jim and Expeditive on social media!

@Expeditive/in/jimyarsinsky/ExpeditiveLLC/+ExpeditiveLLC