Survival in 2012 and Beyond

1. Survival in 2012 and Beyond Lynne P. Byrd V.P. of Revenue Cycle, Archbold Medical Center

2. LEARNING OUTCOMES OF PRESENTATION . • ● Identify practical operation • strategies for survival. • ●Recognizepilots and specific • programs that have yielded • positive operation results. • ●Compareoperation perspectives • from 4 hospital systems.

3. Key Areas of Focus for Revenue Cycle Value Based Purchasing Performance = Reimbursement 5010 and ICD-10 Conversion Do you have a plan? Clinical Documentation Improvement Physician Education & Computer-Assisted coding Career Ladders - Education is Key!! Staff development is essential to survival Denials Management Establish an effective process now Managed Care Contract Compliance Validate your reimbursement

4. 5010 Conversion Key Transactions to validate and test by payer • ●Eligibility– 270/271 • Improved transactions • Improved COB • ●Electronic Claims - 837 • ●Claims Status – 276/277 • ●Authorizations - 278 • ●Remittance Posting - 835 • ●Know what your key payers are doing

5. ICD-10 Considerations What you need to be doing now…….. • HIM Preparation • - Coder Education plan early and provide LOTS! • - Staffing and Productivity • *Recruit now • *Augment with Computer-assisted coding tools • Clinical Documentation Improvement • - Concurrent coding @ bedside • -Improve physician documentation • -Dedicated staff • Cash Flow Protection • - Reduce DNFC • - Reduce DNFB • - Reduce AR days • - Clean up denials • NOW • To make room for the back log!

6. Clinical Documentation Improvement Essential program for ICD-10 success • ●Concurrent coding of the patient record at the bedside • ●Clinical Documentation Specialist (CDS) RNs will work with physicians to complete the documentation needed in the patient’s record for final coding during the stay • ●Medical Records staff will perform final coding • ●Overall goal is ACCURACYof clinical record; and Improved QUALITY reporting → SOI and ROM index • ●Documentation translates into proper reimbursementfor care delivered

7. Value-Based Purchasing Reimbursement Impacted by Performance • CMS will withhold a percentage of reimbursement (excluding critical access hospitals) beginning with 1% in fiscal year 2013 and ramping up to 2% by 2017. • They will then redistribute those dollars as incentive payments based on performance. • 1st Baseline Period complete: July 1, 2009 – March 31, 2010 • 1st Performance Period: July 1, 2011 – March 31, 2012 • 2 Domains for now : • Clinical Process (70% weight) & Patient Experience (30%) • 3 on the way: Mortality, Hospital-acquired Conditions, Patient Safety

8. Value-Based Purchasing

9. Career Ladders Staff development is a primary key to success Patient Access Patient Financial Services • Driven by training and certifications • 5 levels: • Level 1 – HTH Pt Access Cert • Level 2 – HTH Pt Access Spec • Level 3 – HFMA CFC • Level 4 – HFMA CPAR • Level 5 – HFMA ACPAR • Driven by experience, training, and certifications • 5 levels: (under development) • Level 1 – HTH Business office • Level 2 – HFMA CPAR • Level 3 and 4 - • HFMA CFC/ACPAR depending on job code

10. Denials Management This is not new, but more important than ever…… • ICD-10: estimates of • 10-25% increase in government initial denials • Imperative to have effective process in place now as pace will be accelerating • Technical Denials are increasing from all payers

11. Validate Managed Care payments Are your claims being re-priced by a non-contracted 3rd party? Validate your reimbursement Check for “silent PPO” activity Check for unauthorized discounts taken by contracted payers Watch for 3rd party “Re-pricers” being employed by self-insured companies

12. LEARNING OUTCOMES OF PRESENTATION . • ● Identify practical operation • strategies for survival. • ●Recognizepilots and specific • programs that have yielded • positive operation results. • ●Compareoperation perspectives • from 4 hospital systems.

13. QUESTIONS? Lynne Byrd VP, Revenue Management Archbold Medical Center lpbyrd@archbold.org