ILHIMA 2016

ICD-10 Ripple Effect:

Impact on the Revenue Cycle

April 29, 2016

ILHIMA 2016: Waves of Change

Ripple Effect

Concept that states:

Actions always have consequences, either positive or negative. No action is without reaction, and the ripples, in some cases, may be far-reaching.

Your Sphere of Influence

Identify the opportunities with in your influence

Spend the most effort in ring of greatest influence (80/20 rule)

Partner with others in the rings of diminishing influence

Share Subject Matter Expertise while focusing effort in rings of influence

1st Sphere of Influence

Organizations can expect a permanent 15% productivity loss for coders post-ICD-10 implementation

Documentation Challenges

• Coding Productivity Decrease

– IP : 30-50%

– OP/ED: 10-25%, some regaining ICD-9 productivity levels

• Codes per Claims – 100% increase

– ICD-9 5-6 diagnosis per claim

– ICD-10 10-12 diagnosis per claim

2nd Sphere of Influence

Explore management strategies to mitigate financial risk amidst productivity loss including importance of physician documentation process improvements

Clinical Documentation is Key

Measuring the Impact

Assembling the Winning Team

Sample Physician Scorecard

CMI Increases

3rd Sphere of Influence

Leverage partnerships to influence change through knowledge sharing and application of Subject Matter Expertise

Dr. Sirolli and the Zambians

PAS Impact

• Orders

• Medical Necessity

• New Knowledge

• Technology Functionality

78% of billing rework is caused by front end errors. -Advisory Board Co

Prior Authorizations

• Payors still defining requirements

– Grace Period expires Oct 1, 2016

• Michigan Medicaid

– Errors in the mapped Home Infusion Therapy ICD-9 codes to ICD-10 codes

– Causing increased number of prior authorizations

– Delays in delivery of home infusion therapy

Best Practice

• Education of new knowledge

• Impact process

– Develop reference material

– Inform Medical Community (memo, agenda items)

• Share Lessons Learned

– Keep communication open

• What is causing the issue or trend?

– Non-punitive knowledge sharing

Billing Challenges

• Hospitals are reporting fewer claims filed (7 out of 10 Georgia hospitals)

• Advisory Board – hospitals submitted claims

– September- 3.8 days

– October – 6.6 days

• CMS/AMA Grace Period

– Full set of billing edits released Oct 1, 2016

Denials

• Denials

– CMS predicted 100-200% increase

– Q4 2015, decrease 0.17% to 0.07%

– MGMA medical practices average 4% denials

• Clearinghouse

– Relay Health 1.6% total claims

ICD-10 Impact on the Revenue Cycle

Define why a 90-day stabilization period was not realistic and why June 2016 may be the toughest month for hospitals

Expected 90 Day Stabilization

Benchmarks

• Benchmarks change as a result of across-the-board revenue cycle productivity losses in ICD-10.

– Patient access

– Coding

– Billing

– Denials management

Scenario: Today

One Month Later…

Nov 2015

How to Estimate the Impact

Metrics

Predicting ICD-10 losses and tracking key performance indicators after October 1 HCPro Medical Records Briefing, Nov 1, 2015

Change Management Framework

Your Sphere of Influence

Identify the opportunities with in your influence

Spend the most effort in ring of greatest influence (80/20 rule)

Partner with others in the rings of diminishing influence

Share Subject Matter Expertise while focusing effort in rings of influence

Mother Teresa

'I alone cannot change the world, but I can cast a stone across the waters to create many ripples.‘

Contact Information

Kelly Whittle 586-201-4882 @whittleadvisors WhittleAdvisors.com kelly.whittle@icd10advisory.com