Services

Education

Through our Education module, we provide board, executive, physician, and staff education on HIPAA and its background, scope, and long-term impact on payers and providers. Our emphasis is on assisting clients to achieve HIPAA compliance as an ongoing program. We apply a clear strategy and approach to keep clients from reverting to a series of panicked reactions to comply with individual rules.

ICD-10 Education focuses on conveying an understanding of the Transactions and Code Sets Rule and how to best use technology to achieve compliance, including EMR and clinical and business process reengineering in the case of providers and table-driven rules engines in the case of payers. This approach minimizes the cost of compliance while improving the operations of the organization.

To maximize the benefit of Education, we offer customized modules and materials for client organizations.

Gap Analysis

The Gap Analysis module documents the current state of the organization and the "gaps" that must be corrected to achieve compliance.

Major areas of review include:

• Understanding and compliance with HIPAA and impact of ICD-10
• Understanding the current level of documentation and coding capability
• Developing an inventory and evaluation of all information systems - the "as-is" state
• Classifying information systems as legacy, proprietary, commercial vendor-supported, and outsourced
• Developing the "to-be" state
• Evaluating system remediation, replacement, and outsourcing options
  
• Determining information system vendor understanding of ICD-10 and the plan and timeline for ICD-10 compliant releases

Gap Analysis is the first step to compliance. The deliverable from the Gap Analysis module is the Implementation Plan and Roadmap.

Implementation Planning and Roadmap to Compliance

Based upon the results of the Gap Analysis, the Implementation Planning and Roadmap to Compliance module clearly defines the actions, costs, staffing, and timelines required to achieve compliance. Of particular importance is identifying code-driven or code-dependent information systems and interfaces. Alternative timelines will be established depending on whether remediation is possible or a system upgrade or replacement is recommended.

Program Management

Through our Program Management module, we manage or show clients how to manage the ICD-10 compliance program. HIPAA ultimately requires the same tasks regardless of the size of the organization. However, larger provider organizations and most health plans have a higher level of complexity that requires a full-time Program Management function.

Information System Selection and Implementation

Through our Information System Selection and Implementation module, we guide payers and providers in a thorough evaluation of system options to arrive at the best system approach for each client.

Because of the substantial increase in the number and detail of ICD-10 codes, the use of an electronic medical record (EMR) by all providers is, as a practical matter, mandatory, particularly in the inpatient environment. Claims and billing systems developed internally or by vendors not able to provide ICD-10 compliant upgrades will require replacement or outsourcing.

Payers will have to make a similar determination regarding remediation, replacement, or outsourcing of their systems. The cost of remediating a legacy system may be prohibitive for some payers. Unless the payer's competitive advantage is tied to its legacy system, replacement of the non-compliant system could be key to on-going HIPAA compliance.

We use efficient and cost-effective best practices to fast-track the selection process for the replacement of systems. We apply our industry knowledge and research to develop a short-list of vendors meeting major search criteria. Working with a customized client team (makeup of the team being dependent upon the final requirements), we will coordinate system demonstrations and site visits and will analyze the total cost of ownership (TCO).

To reduce implementation time, number of interfaces, risk, and total cost of ownership, the strategy for healthcare organizations should be focused on selecting systems that provide interoperability and complete integration.

Outsourcing Evaluation, Selection, and Negotiations

For some payers, outsourcing applications hosting may be lower in cost and provide less operational disruption than continuing to maintain systems on-site. In addition, payers with many legacy systems and interfaces may not have sufficient time or resources available to achieve compliance by the effective dates of January 1, 2012, for 5010 and October 1, 2013, for ICD-10.

Utilizing more than three decades of industry experience and understanding, TM Floyd & Company will assist clients with the evaluation and selection of outsourcing firms, including advising, guiding, and participating in negotiations.