Top at risk drg s in the post icd 10 era and how to proactively address coding challenges webinar 10-13-15 slide share shortened
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A detailed view of issues relating to Post ICD-10 coding and the strategies available to implement to mitigate financial risk
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Top at risk drg s in the post icd 10 era and how to proactively address coding challenges webinar 10-13-15 slide share shortened
- 1. Sponsored by MiraMed Global Services How to Proactively Address Coding Challenges
- 2. Sponsored by MiraMed Global Services For more information contact: Phil C. Solomon MiraMed phil.solomon@miramedgs.com This webinar presentation has been shortened for the purposes of this SlideShare posting
- 3. Sponsored by MiraMed Global Services 3 For over 29 years Mr. Sornberger lead revenue cycle activities for The Cleveland Clinic and UPMC and has consulted with the largest health systems in the country. He has authored over 2,200 articles for HFMA, AAHAM, and other leading healthcare publications and has been a featured speaker at over 125 healthcare revenue cycle industry events. Lyman G. Sornberger Chief Strategy Officer - Capio Partners President & CEO - LGS Healthcare Consulting Presented by:
- 4. Sponsored by MiraMed Global Services 4 Learning Objectives The importance of documentation and associated risk areas Understand costs to rework claims – re: coding errors & cut your expenses Track performance through executive & operational dashboards Identify top KPI’s and benchmarks that you need to know Create governance parameters for outsourcing with coding outsourcer 1 2 3 4 5 How to pick the right coding outsourcing partner6
- 5. Sponsored by MiraMed Global Services 5
- 6. Sponsored by MiraMed Global Services Polling Question Question How would you assess your systems readiness on October 1st?
- 7. Sponsored by MiraMed Global Services 7 Mitigate Risk Your Post ICD-10 check-up from the neck-up Validate your financial impact and cost Communicate and chart your findings Training strategy & plan What are your strategies? Create a plan and preventative protocol
- 8. Sponsored by MiraMed Global Services 8 Scope of Service Line Education and Awareness - Leadership & Board Impact Analysis – Financial/Performance/Risk Mitigation/Strategies Implementation Strategy/Planning - Program Charter/Budget Estimates Timeline & Dependencies Readiness – Technology/Revenue Cycle/Clinical Documentation/People
- 9. Sponsored by MiraMed Global Services 9 Total Budget $3.1M Capital $800K Patient Access $925K CDI $200K ($140K R) HIM $820K ($500K R) Training $400K ($250K R) Example 300 Bed Hospital Financial Risk/Budget
- 10. Sponsored by MiraMed Global Services 10 Providers overwhelmed discovering effort required for the ICD-10 transition A data-driven approach helps providers conserve resources and limit compliance costs minimizing disruptions ICD-10 Analytics
- 11. Sponsored by MiraMed Global Services 11 Orthopedics DRG’s At Risk Yes No Maybe
- 12. Sponsored by MiraMed Global Services 12 External Exposure Vendor Readiness (C) Payer Readiness (C) Community Providers Coders (CAC / NLP / Offshore Outsourcing) Training Total Cost
- 13. Sponsored by MiraMed Global Services Dual Workflow 13 In-house Outsource Partnership Strategy On/Off Shore
- 14. Sponsored by MiraMed Global Services 14 Benefits and Risks Assess reimbursement shifts Coding Denials Contracting Engage providers in trends Assess revenue risk Promote strategies to mitigate risk Identify revenue maximization opportunities Ask for Handouts
- 15. Sponsored by MiraMed Global Services 15 Fourth Quarter 2015 Assess Lessons Learned from Risk Mitigation Verify Revenue Impact Memorialize Future Training Seek Additional Improvement Opportunities: Denial Management Coding CDI, CAC, NLP Automated Coding, etc.
- 16. Sponsored by MiraMed Global Services 16 2016 Seek Additional Improvement Opportunities Benchmark Peer Performance Verify Revenue Impact Benchmark
- 17. Sponsored by MiraMed Global Services 17 2017 • Establish Performance Targets • Verify Revenue Impact • Seek Additional Improvement Opportunities • Manage Against Reimbursement Changes
- 18. Sponsored by MiraMed Global Services 18 What to Continue Doing Communicate Monitor cash impact Train, train, train Identify problems/shift resources
- 19. Sponsored by MiraMed Global Services 19 What to Begin Doing Trending-peer to peer Manage denial inventory Monitor underpayments Enhance training program
- 20. Sponsored by MiraMed Global Services 20 Questions Contact: Phil Solomon Vice President Global Services MiraMed phil.solomon@miramedgs.com 404-849-8065 Do You Have Any Questions?
Editor's Notes
- Know that you are in ICD.10 “hell” how would you assess your systems readiness on October 1st We mastered the challenge and had no issues. We had some minor “bleeps” but basically it was business as usual. Our clinical, coders, and revenue cycle were not prepared. Our third party relationships (i.e. payers and vendors) struggle (d). We didn’t get a bill through a payer system for at least 48 hours.
- Note the circle and recurring cost Training should be 250K R Green box should be $890K Recurring Cost Remove 2.4M Permanent Cost
- Center needs corrected
- Communicate Monitor cash impact Train, train, train Identify problem areas and shift resources
- Trending-peer to peer Manage denial inventory Monitor underpayments Enhance your training program