Full Transcript for Operationalizing OB: Hospital Perspective

everybody understands how how big this change is. 00:05:52.399 --> 00:05:55.600 Um, so it's just a it's just a huge team. 00:05:55.680 --> 00:05:58.480 And I'm so fortunate that we have that here. 00:06:00.399 --> 00:06:02.000 I'm it's a big system, right? 00:06:02.079 --> 00:06:04.079 You're seeing a lot of patients. 00:06:04.319 --> 00:06:10.560 So um about what time what about when did you start working on this? 00:06:10.800 --> 00:06:19.519 I want to say it was the definitely in the springtime where we started kind of we put together this work group. 00:06:19.759 --> 00:06:23.920 Um, I want to say we have like 70 people on this work group. 00:06:24.160 --> 00:06:24.480 Wow. 00:06:24.720 --> 00:06:35.600 And then we've kind of even further broken that down into like six different subgroups, and then we even have like groups within those subgroups. 00:06:35.759 --> 00:06:51.600 Like we are really putting in a lot of um time and just really trying to look at everybody's perspectives as we go through this because, you know, like you said, you have the clinician point of view. 00:06:51.759 --> 00:07:01.040 I'm in education, you have my point of view, you have um, you know, informatics, you know, they're telling us if we can even do what we want to do. 00:07:01.199 --> 00:07:03.839 Um, it's just an amazing team. 00:07:04.079 --> 00:07:18.879 And, you know, our organization realized that it is going to take a while to get this all done because it's not like, oh, we just are changing a CPT code from one thing to another. 00:07:19.439 --> 00:07:19.920 Right. 00:07:20.079 --> 00:07:30.399 And I'm sure when you started in May, we didn't even yet have the um proposed G codes that CMS put out. 00:07:30.480 --> 00:07:31.600 So no, no. 00:07:31.759 --> 00:07:33.519 That's why it's so important. 00:07:33.680 --> 00:07:35.360 You have to be able to pivot. 00:07:35.519 --> 00:07:40.319 We start in one direction, we get, you know, something comes up and it's like, okay, pivot. 00:07:40.399 --> 00:07:41.360 What are we gonna do now? 00:07:41.519 --> 00:07:42.480 What what do we need to? 00:07:42.800 --> 00:07:52.639 And it's not like we're totally changing what we're doing, we're just kind of broadening our scope of what we need to keep track of um because these things are gonna keep changing. 00:07:52.800 --> 00:07:54.560 And that's just the way it is. 00:07:54.720 --> 00:08:05.519 So yeah, we started beforehand, thought we had a plan, then we get the lovely, you know, message from CMS, and we're like, let's let's add a little flavor. 00:08:06.399 --> 00:08:09.439 Have you received any guidance from payers? 00:08:10.079 --> 00:08:15.600 So we have seen some guidance from different payers. 00:08:15.759 --> 00:08:21.439 Um, a lot of them have told us that they want to wait and see what CMS does. 00:08:21.600 --> 00:08:21.839 Yeah. 00:08:22.000 --> 00:08:27.120 Um, others have kind of given us like this is what we're gonna do in 2027. 00:08:27.360 --> 00:08:36.240

We haven't had as much um communication from what do we do between now and 2027? 00:08:36.559 --> 00:08:41.919 Like from the payers, like they're not really getting us specifics on that. 00:08:42.159 --> 00:08:51.840 They the ones that are responding are telling us on January 1, this is what you can expect, but not a lot for the transitional time. 00:08:52.240 --> 00:08:53.200 Interesting. 00:08:53.519 --> 00:09:00.799 Because um prior to July, we actually met with payers and talked about transition plans, right? 00:09:00.879 --> 00:09:14.720 And we talked about when when it would be good to transition to EM codes or, you know, there's the antipartum codes, um, antipartum only codes and how to use those. 00:09:14.799 --> 00:09:29.200 And um, so did your team come up with something to kind of patch together to work in the because we're now in a season where if you have a new patient come in, they're gonna, they're not gonna deliver in December. 00:09:29.279 --> 00:09:30.240 So great. 00:09:30.480 --> 00:09:31.039 Right. 00:09:31.440 --> 00:09:40.320 So we have kind of looked down that road and we do have like a grid of of what payers are gonna do, which things, what they expect. 00:09:40.559 --> 00:09:42.799 We also have that against timely filing. 00:09:42.879 --> 00:09:51.840 So we make sure kind of keeping up on it, making sure that we don't wait too long to submit something so that it doesn't get kicked out because of timely filing. 00:09:52.240 --> 00:10:05.600 Um, and we actually are starting um to kind of do like a dual thing, like at least let's look at the clinician's documentation, what level of EM service would they select? 00:10:05.840 --> 00:10:10.320 Then we're looking at it from like a provider education to say, does this match? 00:10:10.480 --> 00:10:13.840 Like, is the documentation supporting what they think it is? 00:10:14.000 --> 00:10:20.639 You know, we run that through the coding department to see if they also agree so that we are all educating everybody else. 00:10:20.799 --> 00:10:36.799 And then whether or not we're gonna submit that as an EM today, or whether we're gonna, you know, kind of use like a placeholder and kind of do it later when the when that particular payer is going to accept it, that's kind of what we're working on right now. 00:10:36.960 --> 00:10:42.559 So we are really leveraging as much magic from our EHR that we can get. 00:10:42.799 --> 00:10:48.639 Oh, I want to talk about EHR, but I want to first address your comment about the documentation. 00:10:48.879 --> 00:10:55.360 Are your providers documenting as if they are EM visits right now, or how are you handling documentation? 00:10:55.840 --> 00:11:04.799 Yeah, so for the most part, our clinicians have done a really good job throughout the years on their documentation. 00:11:04.879 --> 00:11:07.519 Um, I think the EHR does help with that. 00:11:07.679 --> 00:11:14.000 There's not that little abbreviated note that we used to see like back in the days

of flow sheets. 00:11:14.559 --> 00:11:19.840 So we did have a good um base for the documentation. 00:11:20.000 --> 00:11:24.240 Of course, there's always, you know, some changes that need to be made. 00:11:24.320 --> 00:11:28.000 Um, but we had a really strong base to begin with. 00:11:28.320 --> 00:11:48.240 Um and then we're just kind of working on strategies more for um what documentation needs to be there for the services that aren't kind of going live right now, like the labor management, which was something that we weren't really focused too much on because it wasn't a billable service under the global model. 00:11:48.480 --> 00:12:00.080 So, like I said, we're kind of looking at things in different phases, also to make sure that we are not overwhelming the physicians and the coders with all the change at one time. 00:12:00.240 --> 00:12:10.799 Let's do it bite-sized pieces with education, take a look at all these documentation things separately, get that under our belt, and let's move on to the next one. 00:12:10.879 --> 00:12:18.159 And we're using it in the kind of the time fashion of like the phases that ObiCare is um going towards. 00:12:18.480 --> 00:12:24.159 I'm glad to hear you mention the OB flow sheet because I still think there are a lot of folks out there that use it. 00:12:24.240 --> 00:12:30.960 It sounds like you guys were already transitioning out of that flow sheet when you um are using your EHR systems. 00:12:31.200 --> 00:12:31.759 Yes. 00:12:32.080 --> 00:12:32.720 Cool. 00:12:32.960 --> 00:12:42.000 And then um for your EHR, do you also utilize an AI transcriber or anything like that to kind of help capture everything? 00:12:42.399 --> 00:12:47.679 Um, so we are in the process of kind of testing out AI in certain areas. 00:12:47.840 --> 00:12:51.600 And so I think we will be kind of incorporating that with us. 00:12:51.919 --> 00:12:58.080 But um, as people might know, when you're working with AI, you have to kind of teach AI, right? 00:12:58.879 --> 00:13:07.200 Um so we are thinking about kind of adding that to the mix, kind of educate everything at everyone at the same time. 00:13:07.600 --> 00:13:11.840 Um, so we are looking at it from from all angles. 00:13:12.080 --> 00:13:21.120 Um, really, we want to reduce the burden to clinicians as well as coders, you know, let's just embrace the um magic that we can. 00:13:21.679 --> 00:13:33.840 You mentioned earlier that you have like an EHR analyst that you're working with, or so are they taking on kind of the reprogramming of your system's EHR? 00:13:34.240 --> 00:13:35.440 Is that how that works? 00:13:35.759 --> 00:13:39.120 So they are reaching out with the EHR directly. 00:13:39.279 --> 00:13:41.120 They are providing the updates. 00:13:41.200 --> 00:13:48.240 Um, we had to have some builds in um, you know, how the clinicians are selecting codes, you know. 00:13:48.399 --> 00:13:58.559 So of course there's all that build around that, but then they're also there to

kind of help us see what we can leverage from them that's going to reduce the burden down the road. 00:13:58.720 --> 00:14:18.159 So we're kind of working with them on lots of areas, um, not just the code themselves updates, um, and then also to see in our reporting, um, because we're also looking to, you know, after the go live, you're gonna have that period where you have to kind of review what's happening. 00:14:18.240 --> 00:14:22.879 And so how can we um use them in that aspect too? 00:14:23.039 --> 00:14:25.840 So, you know, what can we put in a router role? 00:14:25.919 --> 00:14:27.360 What can we put in an edit? 00:14:27.519 --> 00:14:30.879 What can we put that's going to drive a report later? 00:14:31.440 --> 00:14:34.960 Plus help me build what to be built. 00:14:35.120 --> 00:14:39.919 And do we need new dot phrases and smart phrases and templates? 00:14:40.000 --> 00:14:50.480 And, you know, so that's why I said, you know, very fortunate to be on this team of people that is really working to make this successful for us. 00:14:50.960 --> 00:14:54.960 Have you all had to change your operational workflow? 00:14:55.120 --> 00:15:04.320 And I don't know if I'm using the right word or not, but when the patient comes in, they check in, have you had to change that process um much? 00:15:04.559 --> 00:15:06.240 Or what is that looking like? 00:15:06.559 --> 00:15:13.039 So the what we are trying to do is um where does the education to the patient kind of fit in? 00:15:13.279 --> 00:15:29.519 You know, because you know, uh patients that have had a baby in the past or who are currently pregnant before we had this little switch up kind of happen, you know, you're used to they're used to having that one fee. 00:15:30.320 --> 00:15:31.039 More or less. 00:15:31.200 --> 00:15:36.080 I mean, there was always things that were separately billable, but more or less you had that one fee. 00:15:36.240 --> 00:15:49.279 You know, we had a system where we did have like an S a patient estimate for responsibility, you know, encourage patients to kind of, you know, make payments on that so they don't get one big balloon payment at the end. 00:15:49.679 --> 00:15:59.120 So it's really one of one of the parts that we are working with, like with finance and whatnot, is to really say what is the impact going to be to the patients? 00:15:59.279 --> 00:16:01.759 How do we get this information out to them? 00:16:01.919 --> 00:16:05.759 And at what point do we initiate this engine this education? 00:16:05.919 --> 00:16:07.200 Is it right when they call? 00:16:07.360 --> 00:16:10.399 Who is the appropriate person to have those conversations? 00:16:10.879 --> 00:16:15.919 Um, so that's kind of the what we're one of the things that we're working through right now. 00:16:16.240 --> 00:16:28.480 One of the um exciting things about the new codes is that we now know the prenatal care is preventive services, so you shouldn't have a co-payment on that. 00:16:28.559 --> 00:16:34.000 And the postpartum care also is preventive services, so you really shouldn't have a copay on that. 00:16:34.080 --> 00:16:36.080 So it will be delineated easier. 00:16:36.399 --> 00:16:39.279 Many people have been giving that estimate up front. 00:16:39.919 --> 00:16:52.480 It's also educating the patient that yes, even if you know, if we applied these TH modifiers, if everything works well, the payer is not going to assign any cost sharing to the patient, but the patients are still gonna get EOBs that they're not used to getting. 00:16:52.639 --> 00:16:52.799 Right. 00:16:52.960 --> 00:16:56.000 And they're gonna be like, wait, I didn't know that was X amount of dollars. 00:16:56.080 --> 00:16:58.159 And we don't want them to start to panic. 00:16:58.399 --> 00:16:58.559 Right. 00:16:58.720 --> 00:17:08.240 So we need to have that education to the patient, saying that, you know, at the end of the day, it's probably gonna be, I think the word is like budget neutral, right? 00:17:08.480 --> 00:17:09.119 Yes, yes. 00:17:09.440 --> 00:17:16.160 Um, and in trying to explain that to a patient who I had a baby two years ago, I never got all these bills all the time. 00:17:16.240 --> 00:17:23.519 I didn't know it was costing X amount of dollars every time I saw a doctor, whether it's costing me money or not, I didn't know it was incurring that cost. 00:17:24.319 --> 00:17:36.400 But then explaining to them, yes, but at the end of it, that delivery is not gonna be as substantial, right, as it was prior, because we have all these going along the way. 00:17:36.480 --> 00:17:40.000 So it's just you don't want to surprise anybody. 00:17:40.079 --> 00:17:41.920 You want to be as transparent as possible. 00:17:42.079 --> 00:17:50.880 We don't want to overwhelm any patient, and we also don't want a patient to sit there and be like, I'm not gonna go back because it's costing money, whether they're paying it or not. 00:17:51.119 --> 00:17:55.279 You know, we don't want them to see dollar signs and be like, this, I can't do this. 00:17:55.519 --> 00:18:03.680 I think it's so important for the patients to not only understand what's changing, but also like what kind of what their rights are too. 00:18:03.839 --> 00:18:06.880 I feel like this transparency is gonna be helpful, but you're right. 00:18:06.960 --> 00:18:12.319 We need to prepare everybody that you're gonna get those EOBs in the mail or in your email. 00:18:12.720 --> 00:18:17.279 Um, and um most of them should have a zero dollar. 00:18:17.440 --> 00:18:19.599 So they don't. 00:18:19.680 --> 00:18:22.559 Oh, you know, we need to, you know, raise your hand. 00:18:22.720 --> 00:18:29.200 We need to understand this, we need to contact, we need to make sure that the payers understand, you know, the rules. 00:18:29.359 --> 00:18:41.039 Um, so you know, again, it's the patient is part of this team, you know, that we're working towards together because wherever we can get the information is how

we're gonna make it successful. 00:18:41.759 --> 00:18:43.599 So um, provider education. 00:18:43.759 --> 00:18:49.359 Tell me a little bit what you're doing, and then we're gonna go into the worst case and best case scenarios here. 00:18:49.759 --> 00:18:53.839 I want to say that I do more than just like, you know, provide education. 00:18:54.000 --> 00:19:04.319 Um it started, like I said, back in the springtime where I looked at, you know, present-day documentation and I just kind of did like, how would this look in an ENM? 00:19:04.480 --> 00:19:06.480 Where is there, is there any deficiency? 00:19:06.640 --> 00:19:07.839 Do I have any questions? 00:19:07.920 --> 00:19:11.920 Am I understanding the risk of the patient in some of these? 00:19:12.000 --> 00:19:20.480 Because again, I work for a large system and we have anywhere from, you know, midwives, general OBs, perineatologists. 00:19:20.640 --> 00:19:21.839 So we have a wide range. 00:19:22.000 --> 00:19:24.079 We have family medicine OB providers. 00:19:24.160 --> 00:19:35.599 So we offer a lot of different services and really making sure that we understand the risk for all of the patients and where it's gonna fall in leveling an EM. 00:19:35.759 --> 00:19:43.279 So we started off that way, providing education to the physicians, the clinicians, and just saying, yes, this looks good. 00:19:43.440 --> 00:19:46.000 This is what it you know is gonna equate to. 00:19:46.160 --> 00:19:55.680 Um, and then also sharing the findings of that with the coder trainers so that they can educate their coders so that we are all looking at a note in the same way. 00:19:55.920 --> 00:19:58.559 We understand what the clinician is trying to say. 00:19:58.799 --> 00:20:04.400 We know how to, you know, transform that into a billing code. 00:20:04.559 --> 00:20:06.559 Um, so that was one thing. 00:20:06.720 --> 00:20:14.319 But then we're also looking at um, again, workflows, templates, what needs to be added, what do we need to change? 00:20:14.640 --> 00:20:18.640 Um, and just really trying to um look at it from all angles. 00:20:18.720 --> 00:20:22.960 You know, we came up with a system where it was like, oh, this would make it so much easier for us. 00:20:23.119 --> 00:20:26.880 And the clinicians were like, that is so complicated for me to do. 00:20:27.039 --> 00:20:39.440 We're not doing, you know, and so that's why it is one of those things where, again, like I keep saying, having this team approach and and knowing, you know, how it affects everybody. 00:20:39.839 --> 00:20:45.759 Yeah, I love it when I try to solve a physician's problem, you know, and then they look at me like that is not even a thing. 00:20:45.920 --> 00:20:48.079 So exactly. 00:20:48.240 --> 00:20:51.039 So, you know, we we are really just trying to learn. 00:20:51.200 --> 00:20:57.200 It's like, yes, I'm the educator, but I'm also really learning a lot as I'm going, you know, through this process. 00:20:57.359 --> 00:20:59.839 I'm I'm being taught so much. 00:21:01.039 --> 00:21:12.400 One of the questions we I asked on um when I do presentations at conferences and meetings is I ask um what your level of comfort is with the new codes. 00:21:12.480 --> 00:21:16.240 And uh one of the options is I could teach this class. 00:21:16.400 --> 00:21:20.960 And I haven't had anybody say that yet, but I'm very confident that you could teach my class. 00:21:21.279 --> 00:21:30.240 Oh, you know, the hard thing is is, you know, I started um, you know, um in OB back in in 1990. 00:21:30.319 --> 00:21:32.960 So these codes for me have been around for forever. 00:21:33.119 --> 00:21:38.720 So when I sit there and think, oh, there's no more 59400, it's like, okay, it's it, what does that code again? 00:21:38.799 --> 00:21:39.920 You know, it makes me pause. 00:21:40.079 --> 00:21:46.240 It's like, I think I have an understanding of the concepts, maybe not so much the memorization of the codes. 00:21:46.559 --> 00:21:47.599 Oh, the code numbers. 00:21:47.680 --> 00:21:49.279 Yeah, I'm I'm not even there. 00:21:49.519 --> 00:21:51.680 And I I keep talking about it all the time. 00:21:51.839 --> 00:21:53.839 So it's gonna take a while. 00:21:54.160 --> 00:21:55.759 Okay, here we go. 00:21:56.240 --> 00:22:04.480 Worst case scenario, half of your plans or Use the new codes and half of your plans use the G codes. 00:22:04.559 --> 00:22:09.119 What does that look like operationally in your system? 00:22:09.680 --> 00:22:13.839 Well, you know, it does definitely add a little bit more complexity. 00:22:14.240 --> 00:22:23.680 Um, you know, it's but I think as we're going through this, it's like it's just really showing us that we have to build something that is flexible. 00:22:24.000 --> 00:22:28.720 Um, we have to be able to support the different payer requirements. 00:22:28.960 --> 00:22:44.640 Um, we also are trying really hard to not make it be a clinician, like the clinician doesn't need to um understand a patient's payer and rules and requirements of each one. 00:22:44.799 --> 00:22:51.920 So, what we're trying to do is really just approach everything really on a global standpoint, like this is what we need to do. 00:22:52.079 --> 00:22:57.680 This is always going to be the best practice in terms of documentation and everything else. 00:22:57.839 --> 00:23:06.000 And then again, really leverage our EHR and all the magic that it has as much as possible. 00:23:06.400 --> 00:23:14.559 Um, but again, that goes back to having all these different departments there and having them early and involved in these conversations. 00:23:14.799 --> 00:23:33.920 So when our EHR analyst is going back and building something, we're letting them know, you know, there's a possibility we need different options and we're going to rely on you to be able to help us build it so that we don't ask the clinician to do any more than they have to do. 00:23:34.319 --> 00:23:50.960 I I think that is so important because um a

clinician doesn't need to worry about what the what the payer policy is in order to provide excellent care and then also document that excellent care, right? 00:23:51.279 --> 00:23:51.519 Right. 00:23:51.680 --> 00:24:00.720 I mean, and I that's the one thing that I keep trying to explain when I do my education is is we're not asking you to change the way you are taking care of this patient. 00:24:00.960 --> 00:24:01.279 Right. 00:24:01.519 --> 00:24:06.880 There's there should be absolutely no change in what services you are providing. 00:24:07.039 --> 00:24:16.079 We just need to figure out how to give you the templates, the tweaks, the whatever to make it work in the new coding system. 00:24:16.880 --> 00:24:23.440 The new coding system, it does require a little bit more documentation than the the old ones. 00:24:23.680 --> 00:24:32.559 Um so um working towards that will still cover the old um bundled codes, I would imagine. 00:24:33.279 --> 00:24:39.519 Yeah, I I think that's like even when you have payers that are very conservative versus those that aren't. 00:24:39.759 --> 00:24:46.400 If you if you teach everyone to do it conservatively in terms of their documentation, you're gonna cover everybody, right? 00:24:46.559 --> 00:24:55.359 You pick the path that um you know is is going to be have the most requirements, and then you're set for everybody. 00:24:56.319 --> 00:25:00.640 Now the coding and who's dropping the bills is another issue, right? 00:25:02.400 --> 00:25:03.759 That's true. 00:25:06.000 --> 00:25:07.039 Oh dear. 00:25:07.200 --> 00:25:11.359 Okay, but hopefully that doesn't happen and we move forward with all new codes. 00:25:11.519 --> 00:25:20.000 What kind of guidance or resources do you do you feel like you need from the payers to to really make this solid, to make this work well? 00:25:20.480 --> 00:25:24.240 Well, I think we need them to be as transparent as possible. 00:25:24.480 --> 00:25:27.599 You know, we need to know which codes are you gonna cover? 00:25:27.759 --> 00:25:30.880 You know, what's your reimbursement methodology? 00:25:31.119 --> 00:25:35.279 Are you going to impose additional authorization requirements? 00:25:35.440 --> 00:25:35.920 Right. 00:25:36.079 --> 00:25:42.880 Um, you know, is there going to be any payer-specific modifiers or billing requirements? 00:25:42.960 --> 00:25:45.200 Like we all are trying to embrace the TH. 00:25:45.279 --> 00:25:49.039 Are you going to embrace the TH as we are intending it to? 00:25:49.119 --> 00:25:53.920 Or are you going to have your own modifier or whatever? 00:25:54.079 --> 00:26:04.160 So I think it really, and then of course, the biggest one is like, how are you wanting us to handle these transitional patients, the ones who start in one and end in another? 00:26:04.640 --> 00:26:09.680 Um, so I think it's just really wanting to have that transparency. 00:26:09.839 --> 00:26:21.359 You know, it would be fantastic if everybody came back and just had a standardized, you know, path and what they wanted and right, super, super easy. 00:26:21.519 --> 00:26:24.240 But, you know, we like to keep things fun and exciting. 00:26:24.480 --> 00:26:37.920 And I, you know, you mentioned the timely filing requirements, you know, um, because yeah, you don't want to be punished for something because they waited and now you're having to go through that process. 00:26:38.240 --> 00:26:47.920 Um the the um I'm curious if the diagnostic codes will come up and there'll be specific diagnostic codes that they require. 00:26:48.160 --> 00:26:52.559 Um I it's really just trying to to understand all of it. 00:26:52.720 --> 00:27:05.359 And when it comes to these transitional patients, if if the payer's telling me right now, no, you can't submit your ENM today, we're gonna deny it, you know, because today it's part of a global, so I'm not gonna accept it. 00:27:05.599 --> 00:27:13.680 And then we wait until January, then you can't impose like a timely filing on me because that's that's on you, you know. 00:27:13.759 --> 00:27:18.960 So it is that whole thing of really trying to figure out how we're going to work through this. 00:27:19.200 --> 00:27:24.400 Um, you know, and I think partnering with a payer is kind of what we need to do. 00:27:24.559 --> 00:27:29.920 So we have to have those relationships so that we can kind of, you know, get through this process. 00:27:30.079 --> 00:27:32.559 Everybody needs to kind of get through this together. 00:27:32.880 --> 00:27:39.119 From the um backend coder perspective, um, how is that looking? 00:27:39.359 --> 00:27:42.400 Is there some kind of prioritization going on there? 00:27:42.559 --> 00:28:03.039 Or so for any any area that we have to do kind of what we're calling like a look back, like look back and see, um, we are we like I said, we have our timely filing from the payers and we're going to have to kind of use that as our priority, you know, as our prioritized list of of who we're gonna go first. 00:28:03.200 --> 00:28:11.839 If we have payers that have like a 60 or 90 day timely filing, we have to hit them before we hit the one that gives us 365 days. 00:28:12.079 --> 00:28:12.400 Right. 00:28:12.559 --> 00:28:19.119 Um, so again, that's where we have to have this change in in workflows and and whatnot. 00:28:19.279 --> 00:28:28.319 Um, so hopefully the payers are gonna be um up front and as transparent as possible so that we can kind of get through this. 00:28:28.480 --> 00:28:35.119 Um and and I'm really hoping that there's gonna be grace for everybody because all of us are learning. 00:28:35.279 --> 00:28:42.160 We have to be patient with the payers because I'm sure they want to know what they're doing moving forward because they have builds and whatnot on their own end. 00:28:42.319 --> 00:28:42.799 Exactly. 00:28:42.960 --> 00:28:52.400 Um, and so I think if we can all just show grace to everybody, whether it's in our own organizations or externally, that's gonna

be important. 00:28:53.039 --> 00:28:55.200 I I completely agree. 00:28:55.359 --> 00:29:03.279 There's so much that we don't know right now, and then when we do know it, it's just gonna be like a lightning rod, right? 00:29:03.519 --> 00:29:08.559 So we can't run around pan panicking and yelling at each other about it. 00:29:08.640 --> 00:29:10.799 Um, we we need to pull together for sure. 00:29:11.839 --> 00:29:12.480 Good. 00:29:12.799 --> 00:29:15.599 Okay, um, we're wrapping up now. 00:29:15.839 --> 00:29:18.400 So you've done a lot of work. 00:29:18.640 --> 00:29:22.000 You you've learned a lot through this process, I'm sure. 00:29:22.240 --> 00:29:30.880 I was there for the EM code changes, and of course, I've been around long enough to have done the ICD dine to ICD 10 changes. 00:29:32.000 --> 00:29:36.000 The sounds at the level, at a similar level to me. 00:29:36.480 --> 00:29:38.480 Um, would you agree? 00:29:38.559 --> 00:29:39.759 You can disagree if you like. 00:29:40.000 --> 00:29:50.880 I I honestly think in some ways it's more because um I think with with things like um the ENM code changes, right? 00:29:50.960 --> 00:29:52.640 It it kind of was a small tweak. 00:29:52.720 --> 00:29:57.200 It was big, but it, you know, it on the grand scheme of things, it was a small thing. 00:29:57.279 --> 00:30:00.240 It was like, you know, what little thing do we have to get out of this? 00:30:00.400 --> 00:30:03.599 ICD nine to ICD 10, that was a bigger one. 00:30:03.839 --> 00:30:11.279 But again, for for OB providers, they have done this a lot of them from the time they graduated med school. 00:30:11.599 --> 00:30:17.599 Like they have only done this, and it's not just we're not just changing codes. 00:30:17.759 --> 00:30:23.039 I'm not saying you're gonna use 59431 instead of five nine four zero zero. 00:30:23.200 --> 00:30:23.359 Right. 00:30:23.599 --> 00:30:26.559 I'm saying you need to look at this totally different. 00:30:26.720 --> 00:30:32.640 And for those of us who work with residents, is there gonna be an impact to the residents and in their workflow? 00:30:32.799 --> 00:30:34.960 I mean, it just is far reaching. 00:30:35.119 --> 00:30:39.200 Um, and that's why I think it's a little bit, a little bit more. 00:30:39.279 --> 00:30:42.480 And they're also not doing it with everybody else. 00:30:42.640 --> 00:30:51.599 And there are people out there, other, I don't want to say, you know, other other specialties that are like, why are you doing this? 00:30:51.680 --> 00:30:54.559 Like that's worked for forever because they didn't understand it. 00:30:54.640 --> 00:31:05.279 So I don't think they have the same kind of global support necessarily as everybody who switched to ICD 10 or everybody who switched the ENM logic. 00:31:05.839 --> 00:31:06.960 I just love what you said. 00:31:07.039 --> 00:31:27.519 I'm thinking about it right now because it is very targeted and um and so maybe systemically it's not as big, but touching so many people and um isolate kind of isolating some people too through this process. 00:31:27.839 --> 00:31:30.160 Despite all that, you're still a fan, right? 00:31:30.400 --> 00:31:33.440 Oh, I am I am a thousand percent a fan. 00:31:33.599 --> 00:31:41.759 I mean, I can't think of another specialty where you say you're gonna treat this patient for up to a year and you're gonna get payment at the end. 00:31:41.920 --> 00:31:46.240 I can't imagine other specialties saying, Yeah, that works for me. 00:31:46.480 --> 00:31:47.039 Exactly. 00:31:47.200 --> 00:31:50.640 Or any other, any other service in the United States, right? 00:31:50.880 --> 00:31:51.119 Right. 00:31:51.359 --> 00:31:57.680 And not to mention just the, you know, reporting on patients' health outcomes and status. 00:31:57.839 --> 00:32:03.920 And, you know, there's so much more that goes into all this than just really reimbursement and whatnot. 00:32:04.079 --> 00:32:16.720 But, you know, when you think about the the diagnosis codes, you're really trying to keep track of the health status of our patients and our population and and having metrics to see what works and what doesn't work. 00:32:16.880 --> 00:32:18.480 And this is a way to capture it. 00:32:18.559 --> 00:32:23.039 When you only had one code, you couldn't capture what happened to them for six months. 00:32:23.200 --> 00:32:29.519 You couldn't see where they, you know, were go doing well and they dropped down and they came back up. 00:32:29.599 --> 00:32:36.319 You're not going to have that record of you know, success or even just like protocols to kind of dictate things moving forward. 00:32:36.400 --> 00:32:39.680 And that's why I said this is not just a code change. 00:32:39.839 --> 00:32:44.240 This is fundamentally everything changing. 00:32:44.720 --> 00:32:55.839 Um, we've been not able to really um engage with alternate payment models because of the lack of data that we have, exactly like you're talking about, right? 00:32:56.400 --> 00:33:07.279 How how the patient episode goes, what's the ups and the downs, what's the what's the number of visits for the best outcomes, even for the certain condition. 00:33:07.759 --> 00:33:10.960 Um we don't have we don't have large scale data. 00:33:11.119 --> 00:33:16.000 Maybe systems have data, but it doesn't always translate. 00:33:20.960 --> 00:33:21.279 Right. 00:33:21.519 --> 00:33:26.079 Um Yeah, so we're ex we're excited about the data this is gonna provide us. 00:33:26.400 --> 00:33:30.960 Okay, top five things that need to be checked off before January. 00:33:31.200 --> 00:33:33.359 What do they need to do before January? 00:33:33.599 --> 00:33:35.440 Um I had five and only five. 00:33:35.599 --> 00:33:40.000 It's like, you know, really try to understand that, you know, payer landscape. 00:33:40.079 --> 00:33:43.119 Like we need to understand that payer landscape. 00:33:43.440 --> 00:33:53.440 Um, you know, get the documentation and provider education, start doing it

early, keep it going throughout the whole process, don't overwhelm anybody. 00:33:53.599 --> 00:33:56.160 Bite-sized pieces sometimes works better. 00:33:56.960 --> 00:34:06.319 You know, we're really engaging our, you know, EHR, like I have said, and our whole revenue cycle team, you know, realize that it does take everybody. 00:34:06.480 --> 00:34:08.320 This is really a village kind of a thing. 00:34:08.400 --> 00:34:09.920 It takes the village here. 00:34:10.480 --> 00:34:20.320 Um, you know, and and just bring everybody together at the same time to have these conversations so you can see everybody's perspectives. 00:34:21.280 --> 00:34:29.440 And then, you know, we have to, and we're working on this, we have to really develop that post-implementation monitoring plan. 00:34:29.920 --> 00:34:33.920 You know, we need to see how things are actually going. 00:34:34.079 --> 00:34:35.280 What are the coding patterns? 00:34:35.360 --> 00:34:36.239 Are there denials? 00:34:36.400 --> 00:34:38.880 Are there what are the payers doing? 00:34:39.039 --> 00:34:48.000 Um, what what have we found in terms of documentation that, you know, are we now questioning that we didn't, you know, that we thought were was okay before. 00:34:48.320 --> 00:34:50.000 Talk to the clinicians. 00:34:50.159 --> 00:34:51.119 What is their feedback? 00:34:51.280 --> 00:34:57.599 Are we creating something that is truly burdensome and they, you know, it's hard to do good patient care? 00:34:58.079 --> 00:35:08.239 Um, you know, really reach out to the patients, make sure that that what we are providing them has eased their minds because we don't need to add anxiety to a pregnant patient. 00:35:08.480 --> 00:35:08.880 Right. 00:35:09.039 --> 00:35:09.599 Exactly. 00:35:09.840 --> 00:35:18.800 You know, so it's really just, you know, bringing everything together and and and understanding you're gonna pivot and you're gonna pivot a lot. 00:35:19.039 --> 00:35:19.519 Right. 00:35:19.840 --> 00:35:26.400 I just want to go back to understanding the payer landscape because with so many questions that we don't have answers to. 00:35:26.559 --> 00:35:28.559 I really like that you said this. 00:35:28.800 --> 00:35:33.599 Um, about knowing the timely filing requirements for the different payers. 00:35:33.679 --> 00:35:37.760 So you could prioritize how to submit the claims at the end of the year. 00:35:38.000 --> 00:35:47.360 Um are there other like other things that you can know now about the payers, whether they're whether or not they're moving forward with the new codes? 00:35:47.679 --> 00:35:50.079 You know, I wish I wish I had that crystal ball. 00:35:50.239 --> 00:35:54.880 I wish that they would be more um, you know, yeah, able to be more transparent. 00:35:55.039 --> 00:35:59.679 I think really the whole CMS thing has really just thrown everybody for a loop. 00:35:59.920 --> 00:36:04.079 And a lot of payers do get their guidance from CMS. 00:36:04.320 --> 00:36:04.639 Right. 00:36:04.800 --> 00:36:18.639 So, and I I I do want to be, you know, I do want to give them grace too, because as much as we want that information, I know they want the information and they want to be able to tell us what it that information is, you know, because like I see they have to do the same build on their side. 00:36:18.880 --> 00:36:22.400 And I'm sure they're like, come on, come on, November. 00:36:22.800 --> 00:36:25.599 People ask me, like, is there any way you could know early? 00:36:25.840 --> 00:36:28.960 And we say, No, there really isn't. 00:36:29.199 --> 00:36:29.519 Not much. 00:36:30.000 --> 00:36:32.159 No, everybody wants that secret. 00:36:32.320 --> 00:36:34.239 Like, who's the secret contact? 00:36:34.320 --> 00:36:37.760 The, you know, the holder of the, you know, the information. 00:36:38.079 --> 00:36:38.719 Exactly. 00:36:38.880 --> 00:36:45.199 It's the same process that happens every year, and they've not let anybody know much early, I don't think. 00:36:45.519 --> 00:36:48.159 So they're pretty tight-lipped about it. 00:36:49.519 --> 00:36:50.800 Okay, great. 00:36:51.039 --> 00:36:52.320 Oh my gosh, Christine. 00:36:52.400 --> 00:36:54.559 This is I've been taking notes the whole time. 00:36:54.639 --> 00:36:57.519 This has been just so informative for me. 00:36:57.679 --> 00:37:00.880 Um, so thankful that you were willing to join me today. 00:37:01.199 --> 00:37:03.519 Oh, thank you so much for this opportunity. 00:37:03.679 --> 00:37:06.800 Like I said, I am truly honored to be part of this. 00:37:06.880 --> 00:37:09.920 And and I don't know if you could tell, but I am super excited. 00:37:10.159 --> 00:37:10.880 Good, good. 00:37:10.960 --> 00:37:12.079 Thank you so much. 00:37:12.320 --> 00:37:14.159 Um, Christine, for joining us. 00:37:14.320 --> 00:37:33.679 And don't forget, if you have questions, to go to the ACOD Payment Advocacy and Policy Portal at ACODCoding.freshdesk.com, and we will have more of these talking to more folks um behind the scenes and on the ground, getting ready for these new codes, regardless of what's going on with CMS. 00:37:33.840 --> 00:37:36.400 So thanks everybody, have a good day.