Protecting your revenues from ICD-10" Applying a revenue-focused approach to the ICD-10 challenge November 2012

Transcription

1 Protecting your revenues from ICD-10" Applying a revenue-focused approach to the ICD-10 challenge November 2012

2 Agenda" Welcome, introductions, and overview of course objectives Quick glance at the current ICD-10 landscape Overview of the ICD-10 financial risk assessment and why it is important What to expect from an ICD-10 financial risk assessment How to apply findings to address revenue risks How to leverage the ICD-10 financial risk assessment across a conversion Wrap up and Q&A

3 Presenting today" Allison Alavi Director, Marketing and Strategic Communications Ritesh Sharma COO

4 Objectives" By the end of the session, attendees should be able to: Describe the key components of a revenue-focused approach Define what an ICD-10 financial risk assessment is and how it differs from the traditional ICD-10 assessment approach List the major categories of ICD-10 financial risk assessment outcomes Apply ICD-10 financial risk assessment outcomes to mitigate financial risk and drive the better allocation of ICD-10 resources and budget Describe what ICD-10 activities providers should take and when Identify the points during the ICD-10 conversion timeline where a provider should leverage ICD-10 financial risk assessment analytics

5 Attendee poll" What best describes your role within your organization?

6 The ICD-10 landscape" Protecting your revenues from ICD-10

7 Where we are today" ICD-10 Activity Assessment activities Focus on system and IT impacts Intent to delay ICD-10 compliance date announced Significant reduction in ICD-10 activities due to uncertainty Final rule announced Innovators: used the delay to address potential operational and financial impacts Early adopters: refining plans and adjusting to new dates Early majority: revisiting roadmaps and developing detailed project plans Late majority: starting to build conversion roadmaps Laggards: waiting until later next year to start ICD-10 activities Fall of 2011 Feb 2012 Sept 2012 Nov 2012 Timeline

8 Attendee poll" Where are you in your ICD-10 conversion?

9 Current provider challenges" Budget and staff allocation Validating/establishing conversion budgets Allocating staff and adjusting recruiting strategies Remediation, dual coding, training, and documentation Determining the appropriate remediation strategy Defining a dual coding strategy and timeline Prioritizing training and documentation improvement efforts Testing Prioritizing testing including the development and execution of test scripts Automating testing and test data creation Engagement Increasing physician buy-in Increasing leadership alignment Post conversion Monitoring the effectiveness of remediation efforts Monitoring the effectiveness of coder training and documentation

10 Following a revenue-focused approach" Providers stand to loose between 2 and 6% of their current revenues as a result of the conversion to ICD-10 This is driving the need to prioritize all ICD-10 conversion impacts around financial risk in other words, take a revenue focused approach Components of a revenue-focused approach Business involvement key stakeholders from finance and high risk areas need to be integrated into ICD-10 conversations and the established steering committee Strategy mitigating financial impacts must be at the core of the overall ICD-10 strategy Prioritization enablement training, documentation, and staffing activities need to be prioritized by financial risk Leadership support leaders must be aligned around their understanding of ICD-10 s financial impact and the importance of taking a revenue-focused approach Performance measures the organization must have a metricsdriven, detailed view into potential shifts and reimbursement variations Vendors third party vendors have to be prepared to mitigate ICD-10 s financial impact and report on financial and operational performance following the conversion

11 What is an ICD-10 financial risk assessment?" Protecting your revenues from ICD-10

12 Attendee poll" Have you completed a financial risk assessment as part of your ICD-10 activities?

13 An ICD-10 financial risk assessment is " An ICD-10 financial risk assessment is: A way to operationalize the revenue-focused approach to ICD-10 A tool used to measure the financial exposure faced by a provider when they convert to ICD-10 A way to prioritize all conversion efforts to address revenue risk A tool to monitor the effectiveness of all conversion activities and post-go live reimbursements A way to benchmark financial risk across facilities and organizations

14 The differences in assessments" ICD-10 Compliance Two primary approaches: Traditional Financial Strategy and activities are focused on system and IT impacts Assessment quantifies process, IT, coding, and vendor impacts Prioritization is based on business operations Strategy and activities are prioritized by financial risk Assessment quantifies reimbursement impacts Prioritization is based on ICD-10 revenue impacts

15 The different kinds of financial risk assessments" Granularity Manual/High Granularity Rely on consultant hours to perform analysis Provide outputs down to the encounter level Can be costly Are typically limited in scope Manual/Low Granularity Rely on consultant hours to perform analysis Provide outputs at the DRG level Can be costly Are not easily translated into action Software-enabled/High Granularity Rely on software to perform analysis Provide outputs down to the encounter level Are typically lower in cost Provide more actionable, detailed analytics Software-enabled/Low Granularity Rely on software to perform analysis Provide outputs down at the DRG level Are typically lower in cost Are not easily translated into action Manual Software-enabled

16 The different kinds of financial risk assessments" Granularity Manual/High Granularity Rely on consultant hours to perform analysis Provide outputs down to the encounter level Can be costly Are typically limited in scope Manual/Low Granularity Rely on consultant hours to perform analysis Provide outputs at the DRG level Can be costly Are not easily translated into action Software-enabled/High Granularity Rely on software to perform analysis Provide outputs down to the encounter level Are typically lower in cost Provide more actionable, detailed analytics Software-enabled/Low Granularity Rely on software to perform analysis Provide outputs down at the DRG level Are typically lower in cost Are not easily translated into action Manual Software-enabled

17 The typical ICD-10 financial risk assessment process" Step I Step II Step III Step IV Est. Revenue- Focus Perform Historical Claims Analysis Analyze Outputs Apply Results Select Vendor Data Extract Financial Impacts Detailed Planning Strategy Analysis Analyze at least 12 months of claims data Risk Plan Strategic Review Benchmark Data Operational Impacts Risk and Perf. Mgmt Tool-enabled and Automated

18 What you should expect from and ICD-10 financial risk assessment" Protecting your revenues from ICD-10

19 Attendee poll" Does your organization submit or pay based on DRGs?

20 Three primary categories of outputs Functional Financial Categories of Outputs and Considerations" Training and Compliance For each category, you should look for outputs that: Drive actionable intelligence Are easy to read/interpret Provide drill down capabilities Are easily customizable to the audience Can translate into remediation strategies that drive revenue neutrality

21 Functional outputs" Service types/ departments Claims FTE/ Productivity Physicians/ Coder High risk/ opportunity facilities Top encounters at risk of appeals or denials Resources by role and division High risks/ physicians/ coders High risk/ opportunity departments Impacts to RAC/CERT/ ZPIC audits Backfill plan High opportunities/ physician/ coders High risk/ opportunity vendors and interfaces

22 Financial outputs" DRG shifts Organization level risk Payor contracts Summary impact Summary impact Summary breakdown by payor type Highest risk DRGs Medicare Highest risk payor contracts Highest opportunity DRGs Commercial Highest opportunity payor contracts

23 Training and compliance" Physician education CDI Coder education Medical staff Highest risks/ physician ICD-9 opportunities Highest risks/ coder Productivity impacts by departments and service lines Highest opportunities/ physician ICD-10 opportunities Highest opportunities/ coder Risk areas for appeals and denials

24 How to apply your analytics" Protecting your revenues from ICD-10

25 Attendee poll" What is your biggest ICD-10 concern?

26 Applying your outputs" Technology and testing Training, education, and CDI Prioritize vendor systems and interfaces Prioritize physician education Prioritize testing scenarios Prioritize chart review Prioritize testing data Dual coding planning and strategy Prioritize coder training Focused clinical documentation improvement Remediation planning and strategy

27 Applying your outputs" Finance and operations Stakeholder and physician engagement Understanding of implications to financial policy Prioritized staffing decisions Prioritized contract review and renegotiation Greater physician buy-in Greater alignment across leadership and key stakeholders More comprehensive and data driven communications plan Service line-level decision facilitation

28 Leveraging financial insights across the conversion" Protecting your revenues from ICD-10

29 Attendee poll" When does your organization plan to start dual coding?

30 Critical ICD-10 tasks and timing" Example plan Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Budget and funding validation Training and education plan build/ validation Remediation strategy Crosswalk building/ remediation Dual coding and Testing October 2014 Go-live

31 Using financial risk assessments at points within the conversion" Example plan Initial baseline run 2 nd run during crosswalk building Quarterly runs through the dual coding Planning Planning Planning Planning Planning Planning Documentation RevCore Financial Risk Assessment Solution Training Documentation RevCore Financial Risk Assessment Solution Training Documentation RevCore Financial Risk Assessment Solution Training Documentation RevCore Financial Risk Assessment Solution Training Documentation RevCore Financial Risk Assessment Solution Training Documentation RevCore Financial Risk Assessment Solution Training Mapping & Conversion Mapping & Conversion Mapping & Conversion Mapping & Conversion Mapping & Conversion Mapping & Conversion Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Budget and funding validation Training and education plan build/ validation Remediation strategy Crosswalk building/ remediation Dual coding and Testing October 2014 Go-live Enhanced and optimized based on your business goals ICD-9 coding improvement CDI enhancements to support transition ICD-10 crosswalk improvement Operational activity alignment (RAC, other Medicare audits

32 How to monitor financial impacts post October 2014" Post-go live trending capabilities to look for include: Trending capabilities Productivity metrics Variations between ICD-9 and ICD-10 Revenue cycle and AR metrics Denials metrics

33 Wrap up and Q&A" Protecting your revenues from ICD-10

34 Objectives" You should be able to: ü Describe the key components of a revenue-focused approach ü Define what an ICD-10 financial risk assessment is and how it differs from the traditional ICD-10 assessment approach ü List the major categories of ICD-10 financial risk assessment outcomes ü Apply ICD-10 financial risk assessment outcomes to mitigate financial risk and drive the better allocation of ICD-10 resources and budget ü Describe what ICD-10 activities providers should take and when ü Identify the points during the ICD-10 conversion timeline where a provider should leverage ICD-10 financial risk assessment analytics

35 Q&A" Please visit RevLite a DRG-level ICD-10 financial risk assessment tool to get a glimpse into your ICD-10 reimbursement risk Apply for free access to this tool using the following link Be sure to enter promo-code SCHF1129 Protecting your revenues from ICD-10