Though not without a few glitches, ICD-10 is now the required code set. And while the great disruption in claims submission and revenue many feared has not happened, this is no time to let your guard down when it comes to ICD-10.
With the initial work of transitioning to ICD-10 over, here are a few suggestions for what to do next.
Keep a close eye on your claims, denials, rejections, and incoming payments to ensure your practice is not lagging behind under ICD-10. As well, review your productivity for coders, follow-up staff, call centers, and more. While a learning curve is to be expected, be prepared to make provisions for long-term hits to your staffing resources as issues arise.
In their white paper ICD-10: Remediation: Post Go-Live Activities, Optum recommends monitoring the following:
- Increase call volume (document reasons for calls),
- Call wait time,
- Shifts in provider portal usage
- Increase/Decrease in claim volume (IP, OP, professional),
- Daily paid out amount,
- Claims volume,
- Denial rates, pend rates, auto-adjudication rates,
- Claim turn-around-time (TAT),
- Use of unspecified codes,
- Claims lag (IBNR), and
- Changes in case mix.
Calling for Help
If you do identify problems related to ICD-10, don’t just assume they will get fixed on their own or that someone else will report them. Call your vendors, clearinghouses, payers, or other organizations who are responsible for different pieces of the ICD-10 puzzle. The Centers for Medicare and Medicaid Services published this helpful table include who to contact for ICD-10 problems with Medicare or Medicaid.
Not only do coders need to continually learn more about the new ICD-10 code set and guidelines, each year new updates will be made: codes will be added, coding rules will change, some codes will be removed. Also, as the industry becomes more familiar with ICD-10, some coders will find that they have been choosing codes or applying guidelines incorrectly.
Plan for the cost of additional training in your budget and make room for coders to be away from their work from time to time so that they can get the continuing education they need.
In his article “ICD-10 Education Shouldn’t End After October 1, 2015,” Paul Strafer, RHIA, CCS, says the first few months after implementation will be especially important for ensuring coders are properly trained.
“Remedial training will be critical during the first six months post-implementation. This is the time during which mistakes and deficiencies will become more apparent. It’s also the time during which organizations will see first-hand how payers plan to process the more specific ICD-10 codes. Ongoing coder training that evolves over time commensurate with denials and new Coding Clinic references is an essential ingredient of the recipe for long-term compliance.”
Internal Coding Audits
In addition to or as part of coder training, plan for regular, internal coding audits. This will not only allow for mistakes to be caught and corrected but will also provide opportunities to suggest clinical documentation improvement for physicians and other clinicians.
In a recent ICD-10 Monitor article, Warren Hansen says that organizations should plan to audit 10 to 20 percent of all charts over the first six months. “Why six months?” he asks, “That’s when organizations should start seeing improvements.” He also recommends reviewing your reimbursement analytics. “Comparing revenue … year-over-year, beginning with October 2015 by comparing it to October 2014, is essential. Doing so will help organizations find major shifts in reimbursement.”
Improving Clinical Documentation
Most experts agree that clinical document improvement (CDI) did not start with ICD-10 and it will not end with ICD-10. Clinicians can always improve on the type and amount of information they document so that coders can properly select diagnoses and procedures, for that matter. CDI becomes even more important under ICD-10, however, because of the level of specificity often required for choosing codes.
“Clinical documentation improvement initiatives will need to play a much larger role in making certain the specificity needed to most accurately capture the condition and acuity of the patient is present in the documentation,” writes Dennis Price, CFO of The Polyclinic in Seattle, and Jennifer Swindle, Vice President of Coding Solutions, Salud Revenue Partners. “Small changes can have a big impact on the accuracy of the code selected and paint a much clearer picture of the patient to the payer.”
For some practices, the work involved to implement and maintain ICD-10 will prove too much. In those cases, outsourcing becomes a critical piece of your post-ICD-10 strategy. Whether you outsource all of your revenue cycle management or just coding or coder education, choosing the right partners to help you weather the ICD-10 transition is critical.
“Providers that have not outsourced any functions to support ICD-10 may still benefit from support such as coder and physician education,” Price and Swindle write. “Or, providers may want to identify a partner to supplement coding and accounts receivables staffing, to ensure the ICD-10 transition does not impact revenue during the next six to 12 months.”
We no longer have to anticipate the transition to ICD-10, but now we do have to deal with it and learn how to thrive under it. Keep pushing ahead to make ICD-10 work best for your practice.
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