ACA & ICD-10 Success… Make Your Own Luck
Wednesday, March 12, 2014
Posted by: Joy Ingram
by Ray Jorgensen, CEO, Priority Management Group. Ray will be presenting at the Spring Primary Care Conference
“Be prepared, work hard, and
hope for a little luck. Recognize that the harder you work and the
better prepared you are, the more luck you might have.”
-Ed Bradley, American Journalist
We have a saying at PMG… or at least we
did in our early days… “We work without nets.” It is not an original
line and actually credited in my life to a two-person construction crew
we hired to build-out PMG’s third office. Even so, I must admit it seems
all too often to describe my personal and professional life. I am not
an advocate for being ill prepared. In fact, I work hard and have
written before about how to avoid procrastination in general and for
ACA/ICD-10 specifically. However, as folks complained vociferously about
the perils of the ACA… (as we fondly remember the government shutdown)
and now folks are still pushing for a delay or cessation of ICD-10 implementation I feel compelled to offer some thoughts.
So with two months of the ACA’s initial
impact behind us, how did you do? Was there really an onslaught of new
patients? Were your registration specialists truly overwhelmed with new
enrollees? Was anyone’s worry and angst about the ACA’s impact
worthwhile or helpful? Most CHCs we visit have seen little to no change
to their business process. We are quite certain central billing offices,
either those housed at CHCs or their outsourced revenue cycle partners,
will see more third party claims as a percentage of patients formerly
uninsured now access local or national healthcare exchanges. Beyond
this, not certain life at the majority of CHCs will be negatively
This “success” with the ACA roll out
(while not entirely surprising) has created for some CHCs a false sense
of security around ICD-10. We have heard from more than a few CHCs
something like “If ACA went well, why focus so much attention on
ICD-10?” Simply stated, ICD-10 is an entirely different beast.
Here are several thoughts to ponder.
- The scope of the change is daunting (from 14,500 ICD-9 codes to more than 68,000 ICD-10 codes).
- Practice management (PM) and EMR systems MUST simultaneously
maintain both ICD-9 and ICD-10 codes… perhaps indefinitely. Thus, your
CHC must be on the most current PM/EMR offering.
- Your CHC must be able to bi-directionally crosswalk from one code set to the other, i.e., ICD-9 to ICD-10 and vice versa.
- Without thorough testing, your CHC won’t know the preparedness level
of your business partners: payers, clearinghouse(s), and other vendors
(don’t forget lab & imaging partners) with whom ICD exchange is
Now, before panic sets in remember Ed Bradley’s statement above.
- Be prepared…
- Evaluate where ICD-10 impacts your organization and create a plan.
- Schedule training NOW for late spring and early summer… vacation may need to wait this year.
- Transition provider code selection to ICD-10 by mid-summer, allowing
your CHC billing team to crosswalk back to ICD-9… this is VERY doable
and prepares your team well before the deadline.
- Work Hard…
- Don’t know many CHCs are not already doing this, as we see the
skeleton staffing levels remaining after the 2007-2008 economic
- Hold staff accountable for hitting preparedness deadlines. Like
sticking with the exercise and diet before beach season… not easy but
worth it when the plan comes together.
- Get ALL outstanding accounts receivable (AR) paid now BEFORE you
have a huge volume of denials due to ICD-10. ALL low-hanging fruit must
be gathered (collected) immediately. Moving a CHC to 30 days of AR (DAR)
is VERY achievable.
- Be Lucky…
- As stated… the harder you work, the luckier you are.
- Nuff said on that.
Remember, your CHC does not need to be expert at ICD-10 by October 1 but you must do:
- Know what risk areas exist… and be prepared for as many as able.
- Non-payment… clear your credit line and/or know how to access to 3-6 months of expenses.
- Crosswalk is not easy… have general equivalency mapping software
- Have a training plan… and be certain it is fulfilled with period evaluation.
- ICD-10 chart audits… 10 notes per provider?
- Staff testing around ICD-10 rules and nomenclature… who gets it and who needs help?
- Understand obstacles will arise… and know how to rectify.
- Clearinghouse failure… who is back up??
- Payer not paying… who is lead contact at top payers?
- PM/EMR not functioning as expected… invoice to vendor paid up?? Lead contact who returns your calls promptly??
“Worrying is like paying interest on a debt you may never owe.”
This is one of my favorite Mark Twain quotes. Worrying is simply useless.
As a result of these two efforts, your CHC
will be because you’ve made your own luck. The evolving healthcare
system brings constant change. ACA implementation and ICD-10 are the
flavors of the day. Prepare and work hard today to guarantee for
tomorrow your CHC’s optimal performance.
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