The health care process is difficult to understand and the reasons why health care costs are so high might be even more difficult. One thing’s for certain: the cost of medical bills are sometimes way too high. This infographic will show you just how medical bills can have families in big financial trouble.

Click here to see the graphic!

As a medical billing and coding student, you may be faced with the difficult task of finding the time to get that extra 20 minutes of sleep you desperately need. In the infographic below, we show you just how important sleep is and tips on naps to boost your health and keep your cognitive function at a maximum.

Click here to see the graphic!

Small practice (3-9 physicians) = $83,000
Medium practice (10-99 physicians) = $285,000
Large practice (100+ physicians) = $2.7 million

Regardless of size, these costs are big detriments to a company’s bottom line. Since the ICD-10 standards reflect an entire overhaul of the way health care organizations identify, categorize, and catalogue information on diseases, injuries, and infections, gains in efficiencies will not be realized until ICD-10 is implemented and taught to all health professionals.

With that said, short-term costs are one of the biggest concerns of health care providers today. To alleviate some of the uncertainty and costs involved with the transition, Sue Bowman, director of coding policy and compliance at the American Health Information Management Association, says that the best way to prepare is to “get a head start on new transitions”. The following are some of the most important short-term cost considerations to keep in mind while making the transition to ICD-10:

• Although the Nachimson Advisors study outlined earlier provided estimates for the costs of implementing ICD-10, figuring out the exact costs remain the primary concern for health care administrators. As of August, 2011, 49% of respondents in an iHealthBeat survey had yet to complete an initial readiness assessment, which overviews the costs involved. On top of the variable costs that differing organizations may incur, many health administrators are worried about their short term cash flows, which will take a significant hit during the implementation process. In order to account for the true costs and benefits of the transition, administrators should devise a long term plan on how ICD-10 will affect the organization.
• Cost of training existing staff is another main concern for health administrators. In addition to installing systems and training staff, laborious tasks in themselves, the entire training process involves troubleshooting initial issues and maintaining the upkeep on employee training services while transitioning.
• Given the sheer amount of information ICD-10 includes over ICD-9, data management will be a hurdle for health care organizations to cross. A study conducted by the American Health Information Management Association reveals several differences between ICD-9 and ICD-10:
  • ICD-10-CM codes are alphanumeric and include all letters except “U,” thus providing a greater pool of code numbers.
  • ICD-9-CM’s V and E codes are incorporated into the main classification in ICD-10-CM.
  • The length of codes in ICD-10-CM can be a maximum of seven characters (digits and letters) as opposed to ICD-9-CM’s five digits.
  • ICD-10-CM offers the addition of information relative to ambulatory and managed care encounters.
  • Conditions that are new or that were not uniquely identified in ICD-9-CM have been assigned code numbers in ICD-10-CM.
  • In ICD-10-CM, some three-character categories are not used in order to allow for revisions and future expansion.
  • Instead of grouping by categories of injury or type of wound, ICD-10-CM groups injuries by site of the injury and then the type.
  • Excludes notes were expanded in order to provide guidance on the hierarchy of the chapters and to clarify priority of code assignment.
  • Some conditions with a new treatment protocol or perhaps a recently discovered or new etiology have been listed in a more appropriate chapter.
  • Combination codes are used for both symptom and diagnosis, and etiology and manifestations—for example K50.03 Crohn’s disease of small intestine with fistula.
  • Codes for postoperative complications have been expanded. Also a distinction has been made between intraoperative complications and post-procedural disorders—for example, K91 Intraoperative and postprocedural complications and disorders of digestive system, NEC.

Given the differences in coding and categorizing techniques, costs of data management is another uncertainty which will be best revealed as new data in implemented.

• Replacing existing IT hardware and hiring new employees rounds out the top-five concerns for health administrators. With new systems, processes, and information flowing into health care organizations, it makes sense that maintaining a functioning organization and facilitating a smooth flow of information will trump the integration of new hardware and employees. If we haven’t drilled the point down enough, here it is again: devise an initial readiness assessment to forecast your costs to help plan for these changes as soon as possible.

ICD-10 vendors, on the other hand, are information technology experts, having gone through multiple iterations of ICD-10 implementation before working with you. With that said, picking the vendor who is able to meet your needs is one of the most important steps in the implementation process. Here are several guidelines to follow when picking through your suitors:

Align Your Incentives

You are hiring outside vendors to handle your ICD-10 implementation, obviously, as a means of importing their technical expertise to your organization. In order to get the most from your vendor, an obvious, but often overlooked factor is to maintain open lines of communication between you and your vendor. Caroline Piselli, program manager for ICD-10 at 3M Health Information Systems, advises health organizations to, “‘really dive in the weeds’ to ensure you and your vendor understand each other. Don’t assume that you are each talking about the exact same thing.”

For example, multi-facility health organizations will need to focus on inter-department integration, while a smaller practice should focus on maximizing the value of a smaller transition team.

ICD-10 Compatible versus ICD-10 Ready

Not surprisingly, communicating with your vendor about what you need to get done is also a contributing factor for the level of readiness your ICD-10 system is. According to Ken Lacy, CIO at Precyse Solutions, the sheer amount of data in ICD-10 will make it unmanageable without automated systems such as Computer Assisted Coding (CAC). CAC systems may come as ICD-10 compatible versus ICD-10 ready.

Lacy elaborates that ICD-10 compatible systems are just iterations of ICD-9 CAC products, while ICD-10 ready systems are freshly built from the ground-up. Although compatible CAC products will be the cheaper option, long-term problems, such as coding compatibility, ICD-10 transition, lack of auditing software compatibility will result in higher overall costs over the product’s lifespan.
With that said, it’s important to clearly communicate to your vendor what you’re looking for in your CAC programs. If you and/or your team isn’t prepared to manually maintain key aspects of the process down the line, let your vendor know so you can receive an ICD-10 ready product.

Work With Your Consultants

Although the idea of comparative advantage and specialization has created many synergies between health care practitioners and information technology specialists, doctors will remain doctors, and computer engineers will remain computer engineers. Consultants from tech-companies won’t know the nuances of the medical field, while doctor’s can’t expect consultants to know the difference between an excision (cutting out a certain part of a body) and resection (cutting out the entire piece of a body part). Since these huge differences are reflected by small differences in coding, working with your vendor will be crucial to creating an effective product.

So when working with ICD-10 vendors, expect that they are experts in their field, but be humble enough to realize that they may not understand the nuances between how different doctors work. Keep an open line of communication, and make sure you work with your consultants step-by-step to make sure the final product is up to your expectations.

Currently, the deadline for implementation in the United States is set for October 1, 2013. With less than two years to go, meeting the deadline will be a daunting challenge for the entire health care sector. Here are some tips you can follow to help meet the deadline.

Devise a Plan

The planning process is when you should cover all of your bases in terms of training, database implementation, and budgeting. Martha Bethea, CPA, outlines several factors to keep in mind when planning for the shift:

First, in preparation for training, administrators and technical specialists must learn how to understand, document codes in the new format. Bethea emphasizes the fact that “many billing issues arise due to insufficient documentation, so adequate documentation becomes even more important with more specific codes.”

Second, databases and IT systems will have to be updated or completely overhauled to accommodate for the new codes. In comparison to the older version, which contained only 14,315 codes, the new format will contain 69,099 codes with the possibility of further expansion. It will be important for health care providers to determine what their needs are in order to find an ERM vendor willing to provide consulting/implementation services at a reasonable cost.

Third, adequate budgeting will have both short and long-term effects on your organization’s finances. Not only will inadequate planning cause delays in the implementation process, it will also cause “long-term disruptions in the ability of the practice to bill and collect for services.”

Follow Through on Deadlines

It might be tempting to bide your time before implementing the necessary infrastructure for ICD-10. After all, the original implementation date has already been delayed; the feds pushed back the deadline from October 2011 to October 2013 to accommodate for the comments it received from medical professionals.

John Dingle, senior health systems engineer at the Mayo Clinic, heeds warning to procrastination-prone health administrators. Given that Medicare clearly stated their intents on finishing the implementation process by the set deadline, any rumors about changes in implementation dates should be taken with a grain of salt. Instead, Dingle suggests health care organizations to follow through on their self-imposed deadlines and to create a sense of urgency in order to finalize plans before October 2013.

Training and Implementation

The training and implementation process is one which shouldn’t be taken lightly. Jim Jacobs, senior vice president at QuadraMed warns about the potential loss of productivity as a result of the shift of systems. “Without new approaches or without education or without other types of solutions I would not expect the hospitals to have the same level of productivity on ICD-10 as with ICD-9,” says Jacobs.

Given the laborious process of scaling training efforts, which include integrating computer-assisted coding, implementing new processes, outsourcing coding, and employee training, Jacobs believes that only a holistic implementation effort will allow health care organizations to remain productive.

Infosys is a global technology services provider for a wide range of industries. Specializing in anywhere between Aerospace to Utilities, Infosys is currently ranked the 28th largest IT firm in the world. Through using a consulting-style approach, Infosys has recently begun to offer IT services for health care organizations making the shift from ICD-9 to ICD-10 standards.

iTransform

Earlier this year, after a “rigorous and competitive selection process,” Infosys partnered with the Blue Cross and Blue Shield Association (BCBSA) to be a part of its national purchasing agreement. Not only was this a major procurement by Infosys, BCBSA’s proactive planning will allow all of its many partners access to Infosys products, a time and money saving technique (in the long run) by BCBSA. This suite of tools, named iTransform, offers several solutions to payers and providers, including:

ICD Mapping+, a software which allows for customization and creation of links between existing codes. This allows users to create custom notes and links between codes, improving the functionality and amount of information over time.

Payout Simluator, allowing organizations to use historical data to calculate claim payments for different forms of services. This tool will be able to help health care organizations handle claims and prepare for future cash flows under the ICD-10 system much easier.

Impact Analyzer runs SQL queries throughout existing databases to evaluate the impact of ICD-10 on overall data management.

Code Helper, a Computer Assisted Coding (CAC) software, provides an accessible drop-down feature which allows users to select the correct code. By making the code-identifying process easier, the Code Helper aims to reduce the amount of human error involved with the new, more complicated and comprehensive set of codes.

Does it Really Work?

A case study conducted by Infosys on the results of its implementation process with a leading health care insurance provider yielded positive results. Given the fact that Infosys conducted the study to measure the effectiveness of its own products, the results should be taken with a grain of salt.

Regardless, the data shows the benefits of using Infosys’s streamlined iTransform suite, which automates many processes which are typically burdensome and inefficient. The study found using the iTransform suite yielded several benefits, including:

50% reduction in schedule vis-a-vis manual assessment.

80% cost savings vis-a-vis manual assessment.

Helped insurer determine budgetary dollar requirements for the program over the next 3 years.

90% of the code bases were analyzed using various automated code base analysis which generated the impact reports at source code level and provided high level estimations at application level.

Overall, Infosys’s expertise will allow health care organizations to efficiently transition to ICD-10 standards, improve financial forecasting capabilities, and provide more comprehensive support with its CAC services.

Since there are many other companies who provide similar services compared to Infosys, it will be important to identify the needs of your company before committing to a partnership. In the case of BSBCA, the insurance provider had daily interactions with many health care providers providers and payers who rely on reliable systems and information technology to operate. Your company might be smaller or have less responsibilities to other health service providers, changing the range of services to look for in a potential ICD-10 vendor.