CIOs Beef Up Their RCM Operations in the Post-Reform World

Kara Marx R.N., CIO at Methodist Hospital, a 460-bed facility in Arcadia, Calif. feels that the workflow to more tightly align clinical and financial processes is going to be the difference maker, but that’s something that can be challenging right now. “How do we continue to optimize the clinical side and the pieces that help drive that reimbursement?” she asks. “Is it from physician documenting, coding, or dropping off the bill and getting the AR?  It just needs to be much more progressive in identifying the points in revenue cycle that create the delays and bottlenecks. Is it registration? Is it identifying a patient’s eligibility when he or she first comes and communicating what his or her responsibility is? To me, integrating and communicating and understanding the role that each of those stops along the revenue cycle path plays can be the difference maker. It’s not all about technology. In fact, technology can get in the way sometimes. It’s about workflow. You have to find partners who align with your goals and identify the whole picture.”

NEXT STEPS

By Oct. 1, 2014, all U.S. healthcare organizations will have to transition to the 10th revision of the International Classification of Diseases (ICD-10). The standard diagnostic tool will not only improve the medical billing process as a whole, but help patients get appropriate coverage and doctors get paid. Revenue cycle teams will have to invest resources and time to master the new coding system, which will affect reimbursement trends and electronic health record (EHR) implementation.

“ICD-10 is huge part of this,” says Emory Healthcare’s England. “We’re working with a team within our information systems group that is working on ICD-10 preparation. I would say that we’re halfway there now.  And part of that involves going to our vendors and asking if they will be ready for ICD-10. England spoke highly of Ingenious Med’s readiness, saying a big part of that are the vendor’s enhancements with diagnosis searches. “Our physicians have been saying that it’s a huge improvement as previously, they weren’t able to find anything. I can pull diagnoses all day, but they’re the main ones using the tool. If they can’t find what they need, they won’t use it.”

“What would be nice is if there were vendors who said, ‘How can I help you position to code better?’” adds Marx. “Instead of training physicians for ICD-10 (what it is and understanding it), why don’t we just incorporate it into their workflow today? I want to see vendors say that they are going to sell a physician documentation system that has already taken into consideration ICD-10 and will prompt the physician to document better so when the coders get it, it won’t take as much time.”

To this end, there is still is an industry-wide feeling that people aren’t ready for ICD-10, and from the healthcare system side, that is an accurate sentiment, says Hamilton Shawn, executive director at The Advisory Board Company, a Washington, D.C.-based healthcare consulting firm. “Missing one thing can screw you up and make you fall behind if you and the vendor aren’t aligned. In reality, we’re probably six months behind from where we should be. The Office of the National Coordinator for Health Information Technology (ONC) has told us no more delays before, and now they’re doing it again. So there is a feeling that people have—‘Are we ever going to go through with this?’”

Hamilton Shawn

Shawn says that engaging patients and finding a better way to have a financial conversation is crucial for long-term RCM success as well, despite admitting that many patients might not yet be ready. “It hasn’t been a smooth approach so far. I know HFMA is working on that [with its new patient financial interaction guidelines], but it’s time to sit down with them and explaining what’s going on. This is something that is confusing to them, and it will become even more important as we see the road ahead in terms of healthcare reform.”

Looking down the line to what’s coming with us at reform, revenue cycle won’t be the same as we know it, agrees Albany’s Hickman. “We’re going to see a different type of tool suite emerge around how is it that we manage in the world of bundled payments, how is it that we recant our data into other forms so we can do business analytics that we need to better understand bundled payments and population health. “

George Hickman

The Centers for Medicare & Medicaid Services (CMS) recently announced 106 new accountable care organization (ACO) program participant organizations, nearly doubling the national total. But numerous existing patient accounting systems are not currently built to process bundled payments, and most revenue cycle personnel are not trained for this method.