1. Archbold Medical Center
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.
● Recognize pilots and specific
programs that have yielded
positive operation results.
● Compare operation perspectives
from 4 hospital systems.

3. Key Areas of Focus for Revenue Cycle
5010 and ICD-10 Conversion
Do you have a plan?
Clinical Documentation Improvement
Physician Education & Computer-Assisted coding
Value Based Purchasing
Performance = Reimbursement
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 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 ACCURACY of clinical record; and Improved QUALITY reporting → SOI and ROM index
●Documentation translates into proper reimbursement for 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. Patient Financial Services
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
Step 1 Create a Payment Matrix by Payer
Step 2 Audit claims by Payer for correct payment
Step 3 Identify patterns / Incorrect payments or repricing
Step 4 Notify Payer and seek mass claims adjustment

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

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