ICD-10 Implementation is a journey not necessarily a destination – at least for the foreseeable future.

Remember Y2K? The proverbial sky was predicted to fall. It didn’t. Will the long-anticipated ICD-10 implementation be similarly anticlimactic? Probably not. ICD-10 has been dubbed the “complexification of healthcare” in the Washington Post, which also predicted that “the resulting confusion and inconsistency in claims processing would create unnecessary administrative costs and take resources away from patient care.” Texas Medical Association President, Dr. Tom Garcia, has been quoted as saying, “It’s the countdown to a perfect storm.” Whether the financial firmament will come crashing down on providers’ heads due to ICD-10 will depend not only on their preparations, but what they do after implementation.

It may well prove helpful to consolidate insights, tips and best practices submitted by experts around the country.

Let’s first address the Challenges. Despite all the training and preparation, providers still may encounter the following:

1. Productivity decrease. As coders attempt to employ ICD-10, decreasing productivity and inaccuracy-induced delays will have an impact on cost and the bottom line.
2. Financial impact. Cash flow disruption from increased denials and underpayment may also occur.
3. Resources. You’ve allocated required resources to prepare for implementation. Now it’s time to determine the resources needed to keep the implementation on track.
4. Technology-related challenges. These may include data transmission issues and unscheduled vendor updates. You may need to retest critical application or system functionality.

What should you be doing?

1. Create, implement, assess, and continuously correct a post ICD-10 implementation strategy. Take into account that this has not only impacted procedures, policies, and skill sets, but also people—including employee morale. Any change is threatening until employees can acknowledge what practices they need to let go of, deal with the sense of loss of the familiar, can understand and envision what ICD-10 competency can do for the organization and for them personally, and fully embrace the new best practices and skill sets. Tip: Involve your staff in troubleshooting through problem and resolution identification.
2. Assess demands on resources. Address effective allocation of the most impacted resources.
3. Set goals from the top down and the bottom up. Setting goals goes hand-in-hand with tracking key metrics. Involving ICD-10 stakeholders at all levels within your organization is critical.
4. Monitor net revenue and cash trends. Identify, understand, and mitigate the root cause(s) of any cash flow disruptions or revenue declines.
5. Assess documentation quality. Experts emphasize the need for specificity in clinical documentation.
6. Prepare to defend code assignments. Make sure that the documentation is consistent with the ICD-10 coding demands and supports the classification information details. Notwithstanding their inherent differences, learning a coding/classification system and understanding the clinical factors of a diagnosis are related…and important. Tip: Audit coding productivity and accuracy.
7. Training, training, and more training. Training will never stop. Tip: Develop a formalized on-going training program for clinicians and coders.
8. Hire coding help in the short run. Experts can help you assess where you are by conducting audits and working closely with coders and clinicians alike.
9. Review the Q&A document before submitting claims and MDS assessments that include October 2015 dates of service (include SNF clinicians, MDS coordinators, and billers in the review process)
10. Track key preparation and processing metrics. Rome wasn’t built in a day...nor will your process be built over night. If you have not already done so, identify key preparation and processing metrics and track them. Set benchmarks for the near and long term.
11. Acknowledge that it's an on-going process and accept it.

Conclusion

Taking steps throughout the ICD-10 implementation process will prevent the cash flow and bottom line storms from raining on your financial parade. Several resources are available to help you make the transition to ICD-10 successful. For example:

• CMS offers extensive education and clarifying questions and answers
• The American Health Care Association also offers ICD-10-related information.
• Contact primeCLAIMS clearinghouse for additional support

Additional thoughts from CMS

The Centers for Medicare and Medicaid Services have recently offered the following:

• The ICD-10 Ombudsman will be available to help answer nursing facility questions and can be reached at ICD10_Ombudsman@cms.hhs.gov.
• Minimum Data Set (MDS) assessments with Assessment Reference Dates (ARDs) on or before September 30, 2015 must contain a valid ICD-9 code in Section I if a diagnosis code is necessary.  SNF MDS assessments with ARDs on or after October 1, 2015 must contain a valid ICD-10 code.  CMS will reject MDS assessments if a Section I diagnosis code version does not apply for the ARD entered.

Are the rates investors are quoting competitive?
Ever wonder if you’re getting the best rate you can on capital?  It’s a challenging question with a data-driven answer.  In a perfect world, skilled operators would be able to benchmark their performance against others, enabling those with the best performance to prove they are worthy of the best rates on capital.  In a perfect world, investors would have access to current performance data on every skilled nursing building in the country, and be able to set attractive rates for those with a positive and predictable track record of success.   That perfect world is in the process of being created.

NIC to flex muscle…again
NIC is ideally positioned to take on this challenge. Years ago visionaries at NIC set about to change the world of investing in senior housing by creating access for investors to a huge library of regional demographic data.  With confidence, today investors can easily size up markets in which to invest.  Over the years, this transparency has catalyzed development of many senior living products across the nation.

In a recent bold move, NIC announced a new initiative to create transparency with a new data set for investors and operators, dubbed the “NIC Skilled Nursing Data Initiative.”  This visionary program will help answer two strategic questions asked by:

• Operators:  are you getting the right rates?
• Investors:  are you setting the rates?

Today capital is flowing into senior housing, but the challenge is much of it goes to organizations focused on private-pay.  For those serving other segments, it’s an uphill battle to find capital at competitive rates. 

Timing could not be better
Nationwide, skilled nursing properties are aging.  The industry urgently needs capital to modernize physical plants, update mechanicals, and upgrade technologies that are the hallmarks of well-run operations in demand.  According to NIC, “The average age of skilled nursing properties in the top 99 markets is 36 years, making many buildings functionally obsolete.” 

Old data is useless
As new payment models across the skilled sector unfold, operators are flexing business models fast. What used to take years is getting done in weeks.  To lend capital, investors rely on historical government data that is 12-18 months old. As a result, the capital rate an operator is quoted may not reflect today’s operating reality. Current data is needed by investors to set the right rate. They need census, revenue by payer source, and much more.

NIC’s Grand Plan
NIC created a clearinghouse for current skilled data and is making it available to operators and investors.  For investors, this innovation will boost confidence in setting rates for capital that are more closely aligned with performance.  For operators, this innovation will boost confidence that the rates they get are competitive.

The data set
NIC is encouraging operators to submit monthly data in the following categories:

• Occupancy
• ADR by Payor Class
• Overall Revenue Trends
• Total Operating Expenses
• Skilled Mix
• Quality Mix
• Patient Day Mix
• Profit Margin/EBITDAR/EBITDARM (profit margin data is sensitive so it is not a requirement)

In return, subscribers get a monthly summary that de-identifies and aggregates data from all contributors.  Subscribers will be able to compare their performance with national benchmarks. As the database grows, subscribers will over time be able to see regional benchmarks.  Operators will not be able to see the specific data of peer operators for confidentiality. 

How Prime Care Technologies helps
NIC turned to Prime Care Technologies (PCT) to help operators submit data. NIC clients do not have to be current clients of Prime Care Technologies in order to participate.  For these operators, PCT will set up and automate data delivery directly to NIC.  For PCT clients using the primeVIEW business intelligence solution, the data feeds are already in place and the automation required for sending data to NIC is simple and straightforward. 

Ready to opt in?
Take the first step toward fair, competitive rates on capital for your skilled nursing portfolio of properties. Visit the NIC Skilled Nursing Data Initiative and complete the form at the bottom of the page. 

ICD-10: Are you ready?

I have been around the proverbial block of Long Term Care many times over the last 30-plus years. Occasionally. I have seen signs of pending change—sometimes immediate and sometimes off in the distant, protracted future. Rarely in the last 10 years has any change been more dramatic and more protracted than the transition from ICD-9 to ICD-10. And now it’s here, ready or not. 

The New York Times (9/14, A1, Pear, Subscription Publication, 11.82M) reports that the change “is causing waves of anxiety among health care providers, who fear that claims will be denied and payments delayed if they do not use the new codes, or do not use them properly.” While many providers, I anticipate, have prepared themselves for the change, some may be less certain. This may result in delayed or denied claims with disruptions in cash flow.

Is your team ready for ICD-10? There are so many bases to cover, so many details to acknowledge, so many tasks to take on, and so many transitions to tackle. You’ve planned. You’ve trained. You’ve directed. You’ve encouraged. You’ve engaged. But sometimes, it’s the small and basic tasks that can trip you up or elude you, as you make your way around your own potential LTC ICD-10-studded block.

Get a solid footing – check out the basics – one more time

For example, MLN Matters® Number: SE1408 points out that “ICD-10 diagnosis codes have different rules regarding specificity and providers/suppliers are required to submit the most specific diagnosis codes based upon the information that is available at the time.” Here are a few tips from our “ICD-10 Readiness Briefing” to help you round the next billing block on solid ground:
To assure a smooth transition, have a clear picture of your entire claims submission process. Be sure each stakeholder in the process is ready for the transition.

1. Three mission critical steps to confirm ICD-10 readiness. Confirm that:

• Clinicians and biller(s) are trained.
• Your EMR partner has a crosswalk from ICD-9 to ICD-10 codes and has tested its systems.
• Your clearinghouse and key payers have all the new codes in place and have completed their testing successfully.

2. Your claims Clearinghouse should help you to:

• Identify problems that lead to claims being rejected
• Provide basic guidance about how to fix a rejected claim
• Edit the claims to ensure appropriate code sources are used, based on date of service and/or discharge date.

3. Your EMR vendor should supply crosswalks to assist in selecting appropriate groups of ICD-10 codes to use.

Are you ready? What steps has your organization taken to ensure that the ICD-9 to ICD-10 transition is as smooth as possible?

Our free two-page “ICD-10 Readiness Briefing” contains more useful information to make sure you are ready.

 

We are excited to post a press release from Prime Care Technologies about the launching of Healthline, the latest in the fast-growing primeFORCE portfolio of solutions and services. Healthline can be a tremendous resource to help LTPAC providers in the highly competitive world of talent recruitment and retention to reduce call-offs, healthcare claims, and turnover. Please read on.

24/7 service puts healthcare professionals, advocates, and even physicians a phone call away
with no per-call consult fees.

DULUTH, GA, August 25, 2015 – Prime Care Technologies, Inc., the nation’s leader in technology-powered business solutions for providers of long-term/post-acute care (LTPAC), today announced the launch of Healthline, the latest in the fast-growing primeFORCE portfolio of solutions and services.    

An ideal offering for employers in labor-intensive industries where staffing is mission critical to operations, the service includes 24/7 telephone and/or video access to teams of healthcare professionals, without per-call consult fees.  Calls are answered in an average of 16 minutes and can include getting a prescription, when appropriate, from a physician for a common ailment. Other benefits include advice from a nurse practitioner on how to ease pain, help from a billing expert with negotiating discounts to lower out-of-pocket costs, a referral from a vision professional on the right specialist, assistance from a health navigation expert on where to get an inexpensive MRI, and much more. 

“Employees constantly face tough choices, like calling off of work to take sick kids to the doctor, spending hours in crowded urgent care centers, and absorbing high fees towards high deductibles,” explained Joe Stone, Executive Vice President for primeFORCE. “With primeFORCE Healthline, help is just a call away, round the clock, from home, easing fears of lost pay and postponed care. Medications and treatments can start faster, reducing trips to the doctor and call-offs,” explained Stone. 

The benefits to employers are equally significant. On average, Americans visit a physician, hospital outpatient, or emergency department four times per year, at a cost of $104 per office visit and $1,318 per ER trip.[1]  “If employers can eliminate just one of each per employee per year the savings on claims alone add up quickly,” said Stone.  With primeFORCE Healthline, employers experience an average of 3.6X annual ROI, resulting from reduced call-offs, higher productivity, lower turnover, and lower expenses on claims.  “Healthline is a pressure relief valve for busy families, and welcome relief for employers looking for creative ways to keep talent.  Everyone wins,” summarized Stone.

About Prime Care Technologies, Inc.
Headquartered in Duluth, GA.; and with offices in Eustis, FL; and Brookfield, WI; Prime Care Technologies, Inc. is the nation’s leading provider of technology-powered business solutions for providers of long-term/post-acute care.  Clients rely on these technologies and experts to optimize financial performance for procurement, claims, workforce, cloud-IT, connectivity, business intelligence, and more. Having the right information, to make the right decisions, right now—results in tens of thousands of dollars in dividends per location per year.  For more information, visit www.PrimeCareTech.com.  

primeFORCE Healthline is NOT insurance. The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under the Affordable Care Act or Massachusetts M.G.L. c. 111M and 956 CMR 5.00. This discount card program contains a 30 day cancellation period. Discount Medical Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box 671309, Dallas, TX 75367-1309, 800-800-7616. Website to obtain participating providers: MyMemberPortal.com. Not available to WA, VT, KS, UT & FL residents. Telehealth operates subject to state regulation and may not be available in certain states. Consults are not available outside of the U.S.

[1] Centers for Disease Control, American Medical Association, and Agency for Healthcare Research and Quality (AHRQ); respectively.

 

PRIME CARE TECHNOLOGIES launches the long-term/Post-Acute CARE industry’s MOST COMPREHENSIVE SOLUTIONS PLATFORM

For growth and performance-focused organizations, innovations accelerate results

DULUTH, GA, May 4, 2015 – Prime Care Technologies, Inc., the nation’s leader in technology-powered business solutions for providers of long-term/post-acute care (LTPAC), today announced the launch of a comprehensive solutions platform.

Packed with innovations for LTPAC providers to take financial and operational performance to new heights, the breadth and depth of the platform marks an industry first. Providers can now optimize the right mix of strategic applications, answers, and experts—all running securely in primeCLOUD—to solve some of the industry’s toughest challenges. The lineup is accessed at www.PrimeCareTech.com and includes innovations to:

Reduce costs - primeCOMMERCE, powered by Procurement Partners, provides significant cost cutting through formulary management, invoice automation, central contract compliance, business logic and approval workflows; and more.

Improve cash flow - primeCLAIMS cuts claims processing time up to 35-50% and collects cash faster with an enterprise-class claims solution connected to 3000+ payers.

Optimize a workforce - primeFORCE saves time and money by managing a talent universe in one place.

Drive performance and security - primeCLOUD boosts uptime, performance, and security for the software applications, networks, and devices on which business rely.

Simplify interoperability - primeCONNECT enhances application data sharing within and between healthcare partners to reduce information technology costs, coordinate care, improve quality outcomes, and capitalize on financial incentives.

Measure results - primeVIEW business intelligence provides executives information at their fingertips to make decisions in a centralized dashboard. primeVIEW rolls up key performance data from over twenty-five popular applications under a single login.

“Having the right blend of technology is mission critical for today’s operator,” commented Jim Hoey, CEO of Prime Care Technologies. “Prime Care Technologies suite of solutions is supported by a team of business performance experts who help clients streamline people, processes and technologies to maximize quality of life for patients and residents as well as professional satisfaction for the teams responsible for their experience.”

About Prime Care Technologies, Inc.
Headquartered in Duluth, GA.; and with offices in Eustis, FL; and Brookfield, WI; Prime Care Technologies, Inc. is the nation’s leading provider of technology-powered business solutions for providers of long-term/post-acute care. Clients rely on these technologies and experts to optimize financial performance for procurement, claims, workforce, cloud-IT, connectivity, business intelligence, and more. Having the right information, to make the right decisions, right now—results in tens of thousands of dollars in dividends per location per year. For more information, visit www.PrimeCareTech.com.  

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