HSMN announces an expansion of its START Program, the program designed to assess the state of readiness for ICD-10-CM Diagnostic coding and Procedure coding. The expansion has been implemented to support providers who want to know how they will do with their payors once ICD-10-CM is in effect. The expansion includes all payors regardless of where the facility is.
The HSMN START Program will include Managed Care. The payors include all of the large insurers and the States’ Medicaid intermediary who are now using Managed Care as a vehicle to reduce outlays. START is a program whose consultants review the last few years of data to understand payment for procedures and visits as well as the data that shows what has been denied. These data are then compared to HSMN’s data base of comparable facilities to determine whether everything that should have been paid has been paid and establishes that every procedure eligible for billing has been billed appropriately.
HSMN Documentation Specialists review a targeted sample of cases to determine whether ICD-9-CM standards for specificity are being met by the Medical staff. HSMN has in its START Program a module to simulate those same cases in the ICD-10-CM coding/documentation structure. HSMN works to help the current documentation and coding issues while then reconstructing the same cases (targeted based on the data) into a claim which should optimize the revenue and adhere to the appropriate specificity for ICD-9-CM and ICD-10.
Each of these cases is reviewed with the Medical staff and all of those who are part of the Revenue Cycle so that they can see how well they will do in the ICD-10 world. The final step is to emulate how these claims will be paid by your third party payor especially the Managed Care companies.
This effort is essential in determining how well Providers will do. HSMN seeks to go beyond the data and look at the source of the problems which are not allowing the provider to realize the full benefit of the revenue to which it is entitled. START touches every part of the Revenue Cycle and leaves an imprint and model to follow once the assessment is complete.
There are no magic bullets or systems that can suddenly make the Providers have more revenue than they did. In the ICD-10-CM world Physicians/Clinicians are the source of the documentation on which excellent coding should be based.
If a Health System, or Practice or Medical Center is concerned about the revenue based on ICD-10, now is the time to call Health Systems Management Network, Inc. 866-908-4226 or email firstname.lastname@example.org for a consultation.