Don’t relax now: another coding deadline is looming

In a typical Indiana Jones action-adventure movie, our hero is faced with a sudden crisis – a runaway coal-mining car, a dungeon full of snakes, a shrinking room, etc. Against all odds, Indy escapes disaster – only to find himself instantly under assault by Nazis or mummies.

Healthcare finance departments may feel as if they’re in an Indiana Jones film: As soon as one crisis is solved, up pops the next. The latest threat to provider revenue cycles (and sanity) is ICD-10. After months of warning, preparation and dread, the deadline for the new medical and diagnostic coding system hit on October 1.

While it’s still too early for individual providers to truly gauge the impact of ICD-10 on their revenue cycles, just getting through October 1 must have been a great relief. Now, providers face mandatory quality reporting measures in early 2017. Healthcare Finance writes:

“While the practice has been optional so far, in early 2017 providers must submit four of their inpatient quality reporting measures electronically, dubbed eCQM, or they will receive a 25 percent reduction in their Centers for Medicare and Medicaid Services market basket update in 2018.”

How much that reduction translates into depends on the provider, but Tony Panjamapirom, senior consultant of research and insights at The Advisory Board, tells Healthcare Finance that it could cost a mid-sized hospital “a couple of million dollars” and might mean the difference between a profit and a loss.

As with ICD-10, the key to meeting these reporting challenges is preparation. Remember, while February 2017 may seem a long way from now, there was a time when October 1, 2015, was but a distant date.

Panjamapirom recommends that providers first make sure their EHR vendors are ready for eCQM submittals. After all, even if providers get their acts together for the new quality reporting measures, vendors whose systems fail to meet CMS’s specifications for electronic submittals will undermine provider efforts and threaten revenue. Healthcare providers should be leaning on their EHR vendors now to make sure their software is 1) up to date, and 2) certified for the measures that the provider wants to report.

Speaking of which, providers also should report quality measures that play to their strengths. “Choosing quality measures that score higher will not only put a group's best foot forward, but will enable them to see if there are holes in the data,” Worth writes. “For instance, if an organization estimates that 90 percent of patients are receiving diabetes education, but reports show that only 50 percent are, there may be a data problem.”

CMS offers a number of resources to providers in its eCQM library.

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