Forget October 1, Are You Ready For October 16?

Forget October 1, Are You Ready For October 16?

We were all focused on the start of ICD-10, but in a few short weeks healthcare organizations will begin to see the impact of the transition on their bottom lines. Here are some tips on how to mitigate the ICD-10 impact.

ICD-10 implementation and planning has been a like a dust storm looming on the horizon: swirling, unpredictable, and a somewhat painful experience. Because of its erratic nature, for the most part, we have all been focused on the challenges of meeting the deadline. We’ve been preparing, planning, allocating resources, testing, tweaking, and testing again. But what most of us haven’t been planning for are the days and weeks post October 1.

A few weeks into October, organizations saw the positive and negative impact of the new coding practices and outcomes on their revenue cycle. With a large-scale transition like ICD-10, and the massive volumes of cases now being coded using the new system, there will be gaps — no matter how well prepared your organization is, we all must carefully examine our plans and processes.

This is the time to embrace ICD-10 in terms of people, process, and technology. Re-examine your workflow and plans to measure the accuracy, quality, and productivity around the new code set. Here are some recommended steps for mitigating the ICD-10 impact and maintaining data integrity post October 1.

All Codes Are Not Equal
Hospitals and providers need to implement regular audits to evaluate the accuracy of the ICD-10 codes and determine the areas of greatest impact on their organization. With this auditing schedule (I suggest daily and weekly at the beginning, and then transition into monthly), you should also define your metrics for monitoring, as well as a project plan that includes resources and tools, timelines, and specific reports or deliverables. You can use these audits to determine the areas of highest impact, and create a plan for prioritizing and targeting those key areas that are causing the most concern: clinical specialty, physician, CDI needs, or coders to mention a few.

Work With Your Physicians
Once you’ve identified the key areas of high-impact denials, meet with your physicians and clinical documentation specialists to review the required clinical documentation needs for ICD-10 coding best practices. Targeted training and increased awareness about enhanced specificity on a patient’s current conditions reflected in the clinical documentation, or the tests and procedures being performed as a result, can have a profound outcome — both on the continuity of care as well as on compliance, quality scores, and reimbursement. For instance, improving the appropriate and precise clinical documentation for a patient with congestive heart failure will not have the same impact as documenting a patient admitted with severe nausea and vomiting. Reporting and analytics tools can be helpful for identifying clinical specialties and/or particular physicians whose documentation may be lacking the proper levels of specificity.

Measure, Measure, Measure
While some clinical documentation improvement metrics are available, currently there are no industry benchmarks for ICD-10 productivity and/or accuracy. Meet with your team of coders, coding trainers, auditors, and clinical documentation specialists (CDSs) and determine your expected turn-around times for discharge processing and coding, discharged but not final billed (DNFB), and days in medical accounts receivable (AR). Create your own ICD-10 accuracy and productivity targets and metrics and be sure to share with the coding team so everyone is well informed of the evaluation and auditing methods that you will be deploying under ICD-10. Infuse continuous quality improvement (CQI) into your cycle of identifying, reviewing, and evaluating each step; and use your reporting tools and audits to track progress, identify areas for further improvement, retool remediation strategies, and share feedback. This is in addition to tracking metrics such as your diagnosis-related groups (DRGs), case mix index (CMI), and severity of illness (SOI), of course!

There undoubtedly will be hiccups here and there, but having pertinent clinical documentation appropriately entered by physicians at the point-of-care is still the best way to tackle ICD-10-related challenges, in addition to providing tremendous relief to both coders and CDSs, and simultaneously reducing physician frustration levels associated with the querying process. Tools such as computer-assisted physician documentation (CAPD) and computer-assisted clinical documentation improvement (CA-CDI) can be extremely useful, particularly if your organization has narrow bandwidth of staff. The outcome that results from having technology-enabled solutions of real-time specificity physician prompting can help to improve clinical documentation integrity and boost your outcomes reporting that can have a real impact on institutional as well as professional credibility.

While October 1 was an important day for us all, what is even more significant is what will happen in the days and months following the compliance date. ICD-10 is a powerful reporting system that will help improve the accuracy of the patient record and ensure quality care. Making sure your organization has a post-transition strategy in place will help you quickly address any unplanned associated complications.

4 Tips for Success – ICD-10 Conversion and Implementation

4 Tips for Success – ICD-10 Conversion and Implementation


From Cedars Sinai presentation at the AHIMA conference, the following lessons learned are keys to success in your ICD10 conversaion and implementation!  With ICD-10 being implemented this week, are you ready?  Here we go!

  1. Provide ongoing education and re-education for coders. ICD-10 has 68,000 diagnostic codes compared with 13,000 for ICD-9. Even coders with decades of experience are in many ways ‘beginners’ with ICD-10. Initial training will give them the knowledge to start coding in ICD-10, but only hands-on experience and educational feedback will give them the expertise to reach pre-implementation levels of productivity and accuracy.”
  2. Conduct proactive coding audits and assessments. Don’t wait until you start to get coding denials before you audit your coders. It’s important to proactively identify errors and take steps to correct them as they occur.
  3. Increase hiring of inexperienced coders. Traditionally, we’ve been hesitant to hire coders who have completed their education but have no previous experience. Take advantage of the training programs already in place for ICD-10 to recruit coders without real world experience, train them and move them along a career ladder that will build loyalty and reduce turnover.
  4. Evaluate procedures for professional fee coding. With ICD-9, physicians and other professionals at Cedars-Sinai were responsible for entering the diagnostic codes for the services they rendered. We are looking at the commitment required of physicians to learn the new ICD-10 coding system to decide whether that’s the best use of their resources. First and foremost, we want our physicians to be focused on providing patient care. The medical center is exploring the possibility of using coders to do pro-fee coding and training physicians and other professionals in how best to document patient care so as to facilitate accurate coding.

Be sure to contact iData for your direct or supplemental medical documentation needs.  Whether you need coders, transcription, back-office support, or catastrophe planning, be sure to contact iData!

Solution For Your Discharged Not Final Billed Rates!

Supplemental Discharge Summary Report Services
Healthcare leaders who know their financial data points understand there’s one business metric that should never be on the upswing: discharged not final billed (DNFB). If an organization’s bills don’t leave the front door, its cash flow and opportunities to earn interest certainly will.Hospital executives must set acceptable DNFB standards that are consistent in their measurement and organizational-specific issues. So, what can make DNFB rise?

  • Lack of qualified coders (now more than ever with ICD-10)
  • Bills held up for reviews and audits
  • Poor internal review systems between the departments that code records and the clinicians who complete pathology and operative reports.
Most organizations set a three-day threshold for accounts meaning that accounts that are not coded or dropped within three days of discharge appear on the DNFB. Other organizations choose to keep the DNFB at a percentage of overall revenue (e.g. 5%) as their measurement.Hospitals should choose the measure that best fits the organization and stick with it.

Urge collaboration

“Also, develop a collaborative team within the organization that includes representatives from HIM, coding, quality assurance, and others that meets on a regular basis to discuss ongoing issues. In the beginning, this group may meet weekly, and then taper off to a monthly meeting once improvement is seen. In the end, assign the responsibility of the DNFB monitoring to one individual and ensure that they have the tools and resources to review the report, identify process issues, and make corrections.”

In most situations, the CEO or CFO has the HIM director deliver the DNFB rates. Ultimately, the HIM director should lead the effort to improve DNFB rates and should work with representatives from across many groups:  business office, coding, charge-master, admitting, case management or utilization review, quality management, and HIM.

Successfully monitoring and controlling DNFB lies within understanding its cause, says Darice M. Grzybowski, MA, RHIA, FAHIMA, founder and president of HIMentors, LLC, in Westchester, IL.

A HIM department may struggle with getting records coded, Grzybowski says, while other times it may attempt to code the medical record, but find that key information such as a pathology report or dictated operative report is missing.

Success keys
“In some cases, the record is outstanding due to other reasons, such as a problem with a duplicate account number, or there is a question regarding a charge error,” Grzybowski adds. “Whatever the reason, it should be classified in a category and not lumped together for one sum number. The HIM department should work in conjunction with the business office to agree on a method of classifying, tracking, and reporting this data on a regular basis”.How else can healthcare leaders ensure their DNFB rates improve? Grzybowski says leaders can start by:

  • Investing in an HIM operational assessment to identify causes of DNFB and possible solutions
  • Putting an ongoing tracking mechanism in place to monitor DNFB
  • Ensuring the Patient Financial Services (PFS) department and HIM teams agree how DNFB will be defined and measured
  • Enforcing record-completion policies
  • Ensuring that deficiency analysis takes place before coding (within the first 24 hours post discharge) to identify missing data earlier in the life-cycle of record processing, and to improve coder productivity to avoid them spending time searching for missing information
“Those facilities that have undergone a thorough HIM and Revenue Cycle operational assessment can identify the areas that need improvement,” Grzybowski adds. “And by implementing various changes in process, adjusting staffing, or providing better analytical tracking of the DNFB, problems can be avoided with the proper solutions.”
Staffing and technology

Be aware that a shortage of qualified, credentialed, and experienced coders can make your organization’s DNFB rise. A lack of an adequate staff working seven days a week in the scanning, analysis, and coding areas could mean higher rates, Grzybowski warns.

“ICD-10 will most probably make that shortage more severe and have a detrimental effect on DNFB,” she says. “Electronic health records and a good electronic document management system that makes physician completion of record deficiencies easier to manage actually helps improve and decrease the DNFB rate.”

Solution Space

iData provides exactly what you need to substantially reduce DNFB rates at your facility. We understand the task workflow for DSR needs identification, connectivity, DSR completion, quality control, and completion. Generally, the following soon-to-be-patented work flow needed to help your organization includes:
1)    The hospital must give EHR access (ADT, EMR demographics, MR or Episodic #s, etc.) to the complete inpatient medical record (security agreements, BAA, unique access for each physician dictator, etc.).
2)    The hospital would need to identify the records that need to have discharge summaries dictated:
  • Create a queue/ work-list
  • Responsible/attending physician would need to be specified.  This will be the physician who has to eventually sign off on the discharge summary document.
  • Defined time-frame (i.e., day of discharge, day after discharge, etc.)
3)    iData physicians review the inpatient medical record and dictates the discharge summary report.
  • Identifies any issues or need for clarification (i.e., conflicts, specificity, missing/incorrect info, query opportunities)
4)    iData transcribes the discharge summary document and returns it to the hospital for authentication/signature by the responsible physician.
  • Discharge summary report now available in EHR in draft (unsigned) status
5)    Responsible physician reviews discharge summary
  • Any issues/discrepancies -> report sent back to iData to be addressed
  • No issues/discrepancies -> report signed by physician and finalized in HER
Call iData today to help you with Discharge Summaries Reports, reduce your DNFB rates, increase your top line revenues and cash flows – all in a tightening health care market.

Part 3 – ICD-10 is now down the stretch… now what does your practice do?

Part 3 – ICD-10 is now down the stretch… now what does your practice do?

Continuing with our Series about what medical practices and hospitals should be doing now that we are slowly running out of time to design and implement an ICD-10 compliance strategy.  For other Parts in this series, please refer to related blogs.

5. Master the codes that matter
While many physicians have memorized the codes they use in ICD-9, which is harder to do in ICD-10, because the system is more elaborate. Instead, experts recommend focusing on learning the codes relevant to your specialty, rather than all 155,000 codes. “Make a short list of the codes you have to be good at,” says Lance. Place the list for you, your team members, and other staff all over your practice. Until ICD-10 takes hold, challenge each other with ICD-9 to ICD-10 conversion codes quizzes – “Hey, if I have an ICD-9 code for X, what is the ICD-10 up-code or equivalent?”

For practices and specialties that have complicated coding, use a medical documentation service like iData’s coding process – coding expertise using a mature coding workflow that is topped with a sprinkle of subject matter expertise.

6. Diminishing efficiency and productivity

Be prepared for changes to your coding affecting other aspects of your practice’s operations—and divert resources, dollars, and staffers from other tasks and budget items. Look at where your workflow is going to have to change. ICD-10 is no longer about an “if”; rather it is about a “when” and the sooner your practice gets ready and is positioned well at the starting gate, the less impact to productivity (and commensurate revenue) you will experience.

Consider that many taken-for-granted task such as referrals, supply orders, equipment and service orders that were handled within the ICD-9 world, will now need to contemplate how they are created and generated in the ICD-10 world. Be sure that your entire workflow has contemplated the wide-ranging effects of ICD-10.
7. Quality, quality, quality

Every practice should have a point person assigned to regularly check coding to make sure there are no errors that are costing the practice money—and identify staffers who need more training, say experts. The stakes are high for practices that don’t get it right because errors may lead to delayed or denied claims.
No practice can afford to make big mistakes that affect cash flow today, especially in the financially and regulatory tightened and rapidly changing medical field.

Whether small, up-and-coming- or large practice, or if you are the HIM or CIO or a local or large hospital, contact iData to assist you with resourcing a team of expert ICD-10 leaders and coders. iData will readily demonstrate the efficacy of our process, offer free pilot-scale tests, help your transition, and Go Live sooner than you can imagine.

Part 1 – ICD-10 is now down the stretch… now what does your practice do?

Part 1 – ICD-10 is now down the stretch… now what does your practice do?


Okay. Take a deep breath. Exhale. Doesn’t that feel good?


As many of us in the medical documentation world feel, this is becoming more and more the scene of uncertainty, anxiety, and “could we just get this ICD-10 over with?” feelings.  How soon we forget.


Remember Y2K?  The build up.  The hype.  Fear mongering. Predictions of end-of-world scenarios with images of digital and financial world implosions. Armageddon.


None of it materialized. But – and this is important – it didn’t materialize because redundant planning and execution of intelligent strategies were implemented at the strategic, tactical, and technical levels. Neither will any of the hyper-sensationalized scenarios about ICD-10 – from regulations to promulgation to implementation.


As a medical documentation organization, we here at iData, LLC have our own considerations and anxieties. iData engaged and employed national experts and is now wrapping up its preparation to handle large volumes of inpatient and outpatient coding. The good news is we can now share with you some strategies to help you prepare your practice for ICD10:


1. Your Practice is coming down the “stretch” – don’t expect another delay


Many medical practices got lucky when the ICD-10 implementation deadline was extended because they had procrastinated on learning it. While it is statistically possible the deadline could be postponed again, all indicators now suggest it is unlikely. Hope was a strategy, but it wont is this time. While the time to invest time and dollars in a measured way is virtually vanished, you still have time, even though it may look like a mad rush.  Believe it or not, there are a lot of physicians who have their head in the sand on this, and it’s going to come back to bite them.


For those of us just dipping our toes into this, you will quickly learn that it’s a radically different coding system from what ICD-9 is. There’s going to be a pretty steep learning curve, which will undoubtedly create an initial significant decline in productivity.

We at iData have been immersing ourselves over the last 2+ years in the ICD-10 world and have sadly endured the disappointment, costs, and frustrations related to the delays as well as the complicated labyrinth involved in implementation. iData has now evolved its coding process to take on virtually every type of ICD-10-CM/PCS challenge with a mature, quality-heavy workflow. At the core of our business model is the employment of nationally recognized ICD-10 subject matter experts that actively assert their quality expertise for the benefit of our clients.


2. Budgeting bandwidth


Complying with ICD-10 requires a substantial investment, so make sure you plan for outlays to cover training, additional software or upgrades to your existing programs, and other costs.

A small medical practice of 1-2 physician could expect to spend $5K-$15K to update their EHR system to manage ICD-10. If some members of your team have learned the system well, you may be able to offset some of the additional overhead by having them train others.

At the end of the day, you will pay now or later. Believe us, managing this too little too late will be orders of magnitude costlier for your business.

The Big Era of Big Data: Risk and Reward in the Age of Digital Health Care

965897_data_01It’s how Wal-Mart discovered people buy more Pop-Tarts before a big storm. It’s how researchers in Canada discovered when vital signs are unusually stable there is a correlation to a serious fever 24-hours later.  It’s how air traveler’s can determine which flights are likely to arrive on time.  What is it?  Big data.  And it’s potential for tracking and predicting the future is, well, big!

Read more

Planning for the Hospital of the Future

Red cross 1During the season of gratitude, we’re thankful for hospitals – and not just because they heal the sick.  They’re customers – and our interoperable clinical documentation services empower their mission.  Never before in history has the patient record received so much attention.  And our own industry is adapting to change along with the rest of the healthcare marketplace.  So we have a vested interest in learning what they’re innovating under pressure, and expanding patient base.

We wonder, wouldn’t they like to just close the doors for a day and think, plan and strategize?

Well, a few of them left their hospitals long enough to brainstorm with others in the name of progress.  In November 2013, U.S. News and World Report gathered hospital executives and experts to the first annual “Hospital of Tomorrow” forum.  One thing’s for certain – the times, they are a-changing.  The strongest will thrive, and they inspire us to do the same.

The Inaugural Launch

Cleveland Clinic CEO Toby Cosgrove launched the inaugural forum coordinated by US News & World Report with a keynote speech, discussing the issues with which hospitals are coping right now.   (Watch it here.)

A panel discussion about the changing face of hospitals and health care ensued, as did break out sessions that included topics such as staffing solutions, designing hospitals for the 21st century care,  absorbing the newly insured, and new strategies for preventing re-admissions. Big stuff.

As you can imagine, the Twitterverse lit up with discussion, collaboration and debate under @USNHOT13.  Round up the industry’s best and the brightest, and you’re bound to conjure varied opinions and passions!  Check out the tweets, pictures, quotes and musings posted during the conference.

For HIM’s and IT and records managers who didn’t get to go, check out a recap of two technology related issues discussed at the forum:

Uncovering the Power of Big Data

While navigating massive amounts of information is nothing new to hospitals, “Big Data” is the latest buzzword that’s got everyone talking.  In the context of medicine, innovative thinkers will figure out how to sift and utilize key data to predict and solve clinical issues, and also, to facilitate better hospital management.

According to the US News & World Report, Brad Ryan, a general manager at IMS Health stated, “Effective interpretation of Big Data can help identify which new technologies are working and which aren’t.” (Shameless plug:  iData’s customers enjoy the delivery of critical data that can be parsed, extracted and exploited for purposes other than the EMR.  In the future, what if treatment could begin before the patient experienced real symptoms, just indicators, for example?)

Is your hospital harnessing the value of the enormous amounts of data to collect genetic information, spot business trends and more?  It’s an enormous task and we’re curious how others are mining through to find the “diamonds” contained within.

Applying Technology to Hospital Business Needs

We often think of technology related to medicine in terms of patient care, such as robotic, or computer assisted surgery.  But one breakout session during the forum apparently discussed the need for technology to empower the business side of healthcare.

Troy Kirchenbauer, general manager of Aptitude LLC, an online direct contract market for healthcare, talked about the critical need for effective supply chain management.   Their platform serves as a transparent and open space in which hospitals negotiate and manage contracts.  Their service builds thriving partnerships between hospitals and suppliers, driving down costs, promoting compliance and improving efficiency in supply chain management. (Visit for more.)

We applaud the great work done by US News & World Report to knit together invested providers, legislators and vendors to sharpen the sword together for the good of everyone’s ultimate customer – the patient.  We look forward to hearing about the next forum.

For a full recap of the topics discussed at the forum, click here.  Want more tips, information and news related to healthcare documentation, IT and administration?  Sign up for our newsletter in the upper right hand corner!


Image courtesy of Dreamstine.

What’s a Medical History Worth? Security Breaches Spiking in 2014

data-security-1-1124500-mRetailers like Target aren’t the only organizations suffering high profile breaches in data security.  As predicted, the healthcare industry has been highly susceptible to data breaches, and the trend’s going to continue to spike in the rush to digitize health care records.  According to a piece in Computerworld, “Recent research from Experian suggests 2014 may be the worst year yet for healthcare data breaches, due in part to the vulnerability of the poorly assembled”

Oh, that again.  The botched launch of and the organizational infrastructure behind the implementation is so complex that too many parties have access to personal data vulnerable to infiltration.  Plus, the industry is now adding another 7 million people to the rosters, expanding the opportunities for theft.

The savvy bad guys, sinister hackers and wayward employees pose significant and costly threats.   Efforts toward protecting data security, for some once considered a nuisance and perhaps even a luxury, must become a top priority for healthcare providers at every level.

Recently, SANS and Norse, private companies specializing in cyber security training and certification, issued a report claiming cyber attacks are responsible for epidemic breaches in healthcare data security.   Cyber criminals and nation-backed operators are constantly devising new ways of exploiting the Internet to carry out advanced persistent threats (APTs), malware infections, cyber espionage, and data and intellectual property theft.   Read the details here.

Why do fraudsters want to get the skinny on your health care data?  Because it is valuable.  Identity thieves feast on records suitable for use, selling them for $10 to $12 on the low end to upwards of $50 if the information can be used for medical and insurance fraud.  It’s expensive for all involved – the consumer often pays, because they’re not always protected as in the case of retail commerce, but class action suits can also cost healthcare organizations a pretty penny.

What are the risk factors associated with the surge in data breaches?

-Lack of experience.   Many participants in the industry, including the sole practitioners, aren’t adequately trained in the skills required for data management.

-Haphazard IT practices.  Even professionals can be careless.  Sometimes anti-malware software is installed but never turned on, for example.

-Employee Error.  Problems also arise just out of error and carelessness – lost laptops, failure to shred paper, careless login practices, etc.

What are key steps in protecting critical data on behalf of patients, and protecting your own organization from costly litigation?   Devise and implement a plan that includes installing the proper software, train employees about the potential risks and the importance of access integrity, and manage the recycling of aging hardware with extreme caution.  Easy, right!!?

As always – hiring a professional to navigate the process is an investment that might cost now, but could save a lot more down the road.  (Just like hiring a company to manage transcription!)


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The ICD-10 Needs YOU

leading-the-pack-480908-sIt’s going to happen, right?  As soon as we finally cross the finish line to the ICD-10 transition, surely there will be plenty of skilled specialists on-hand to navigate the thousands of new codes to master.

Well, not exactly.

According to a piece in the ICD10 Monitor, “Limited coding resources long have been an industry reality. According to a June 2011 survey by the American Health Information Management Association (AHIMA), 40 percent of respondents said shortages were the result of a lack of qualified coders. This mirrors similar findings from a 2009 AHIMA survey on coding practices. In a discipline rife with change, the coder shortage problem only will exacerbate problems as organizations migrate to ICD-10.”


Truth is, despite continued unemployment, medical coders remain in high demand.  Their work ensures critical payments and reimbursements travel through the billing cycle, and preserves the integrity and accuracy of the patient narrative with regard to procedures, diagnosis and billing.   Theirs is a critical role done without fanfare, quietly underwriting the healthcare marketplace’s profitability and patient satisfaction.

So why do we care?

It is in our interest for skilled medical coders to be in plentiful supply, as coding and transcription reside hand in hand.  The reports we painstakingly transcribe, or the data we enter into the EMR are turned over to coders.  Our work feeds theirs, and in turn, their efforts ensure the text we transcribe is accurately input into the system.

So what does it take to become an expert medical coder, able to leap tall buildings and wield 141,000 codes in a single minute? According to AHIMA, the following:

  • The ability to work independently
  • Strong knowledge of the medical terminology
  • Adept critical thinking and communication skills

Ideally, candidates for these careers are detail ninjas.  They naturally demonstrate a precision, and never accept the status quo.  They dig deeper, ask questions, check their sources, and dot their i’s and cross their t’s.

While there is no specific formal education required, many employers seek candidates with a Certified Medical Reimbursement Specialist (CMRS) certification. The process takes roughly a year to finish, and includes information about basic physiology, anatomy and the sciences. Other important components of the certification include:

  • Medical terminology
  • Computer database management
  • Billing and coding procedures
  • Insurance procedures

Think you’ve got what it takes?  The opportunities for medical coders and specialists are only going to increase. As health care providers and hospitals scramble to determine whether to outsource, or train new talent internally, the savvy job seeker wins the race to October 1, 2014.

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