Shoring up against health reform's tidal wave

With health reform finally passed--and many amendments likely to materialize over the next few years--expect lots of talk, speculation and anecdotes about how and when this tidal wave will lap at your shore. From Medicare payment changes and increased access, to ICD-10 and more emphasis on clinical and revenue cycle analytics, this is going to be some kind of whitewater!

Your first soaking will no doubt come in the form of increased audits--and not just from the RACs, of course, but also from Medicaid Integrity Contractors and the 'Zone Program Integrity Contractors.'

You'll find several sessions speaking directly to this intensifying pressure, with emphasis on how to proactively identify your weak spots, recognize potential audit triggers and paddle your way through the appeals process. And there'll be no shortage of vendors trying to convince you that theirs is the best RAC-proof system under the sun. It might pay to get up early on Tuesday to learn more about the technology components you'll need to manage your medical records and appeals process so you'll have a better idea of what to ask vendors once you hit the floor.

Reform will also bring waves of newly insured at the individual level and "enormous" pressures from the commercial end, as Pamela Sedmak, senior vice president and CFO at Blue Cross and Blue Shield of Minnesota, recently predicted. Though few sessions address this coming challenge, we imagine there will be more than a little scuttlebutt about it during sidebar conversations. What with increased competition, rate scrutiny and mandatory minimum medical-loss-ratio requirements, you can bet your commercial insurers will look for ways to boost their margins in every way possible--starting with what they're paying you.

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