GeBBS Healthcare RCM Blog

Dual Coding Could Minimize ICD-10’s Impact on Revenue

Posted on Tue, Jul 28, 2015 @ 07:00 AM

 

11236638-medical-codingDual ICD-9/ICD-10 coding can generate benefits that far outweigh the negatives, if it can be done without creating productivity declines and revenue cycle slowdowns.

There is a huge cost factor to dual coding if you have to do it manually; however, there is a way to dual code without involving every coder on your staff in the process. Technology is available today in the form of computer-assisted coding (CAC) tools.  CAC is a proven technology that automatically derives and assigns ICD-10 medical codes from within your clinical documentation with a 95% accuracy rate. For GeBBS, its proprietary algorithm built in its iCode coding platform leverages deep data learning principles of both ICD-9 and ICD -10 codes.

With this kind of technology, your organization can dual code in ICD-10, while still maintaining your present ICD-9 workload.  These CAC technology solutions can work with your electronic health record (EHR) and financial systems to produce extremely accurate coding.

These systems do not replace your professional coders; they just aid them and ensure improvement: accuracy, compliance, productivity and consistency, while your facility is “getting up to speed” on the new ICD-10 codes.

CAC combines expert workflow technologies, rules-based automation, and certified coders to guarantee accuracy rates of over 95%. CAC features include:

     • Works with all input formats (including HL7, Doc, PDF and TIF, scanned paper reports)

     • Works across all medical specialties

     • 95%+ accuracy

     • 24 hours turnaround time

     • No implementation costs

Dual coding using CAC technology will allow you to:

  1. Analyze your provider documentation and identify areas of risk, offering a clear picture of which providers require additional education, and which providers could serve as physician champions
  2. Assess the quality of your ICD-10 coding, which will enable you to identify the need for, and implement needed education
  3. Provide real time data and explicit direction to the clinical documentation improvement (CDI) staff
  4. Conduct time studies enabling HIM professionals to better prepare for their specific organizational needs through analysis of real time data and actual productivity metrics, rather than planning needed ICD-10 go-live support based on  artificial data
  5. Test claims with insurance carriers, providing opportunity to identify and correct claim submission errors prior ICD-10 go-live

Some CAC technologies come with secure cloud-based auditing systems that work in conjunction with your EHR and coding platforms to provide complete medical record auditing that optimizes and accelerates your coding audit process.

Dual coding using CAC also enables financial modeling to determine how certain diagnosis-related groups (DRGs) might be weighted differently, how the new codes will affect reimbursement levels, and what edits may be required. This provides insights into the impact on net revenue or where additional or more comprehensive documentation will be required.

Tags: ICD-10, Best Practices

Healthcare Financial Professionals Seek New Ways to Rescue Revenue Cycle Management

Posted on Mon, Oct 06, 2014 @ 10:59 AM

Business pressures are forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes. Shifting payment models, new regulations and healthcare reform are forcingHealthcare Financials healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.

Most hospital CFOs and group practice managers have no choice but to look for next generation of RCM solutions in order to keep their organizations solvent. Reimbursement challenges and coping with increased self-pay volumes have driven many marginally performing healthcare organizations to the brink.

In 2014, it is predicted that changes, such as reduced reimbursements, payment reforms, accountable care organizations (ACO), ICD-10 coding transition activities, physician practice acquisitions and increased self-pay collection costs will all contribute to overall declining margins. The increase in self-pay accounts will be significant, driven the Affordable Care Act (ACA) which is going to send a huge number of newly insured patients into the healthcare delivery system. Under ACA, every U.S. citizen is required to have some form of medical insurance, or pay an opt-out fine.

Not only will physicians and hospitals be swamped by treating this new wave of patients, their infusion into the healthcare system is going to create significant financial challenges due to many of the newly insured patients having extremely high deductible insurance plans, forcing hospitals and physician groups to collect this money on their own. According to a January 2014 article in Kaiser Health News, out-of-pocket payment amounts under the ACA will range from $6,350 for individuals to $12,700 for families.

This new pressure on healthcare providers’ revenue cycles is not going away; it’s something everyone will face soon.

Tags: ICD-10, Revenue Cycle Management (RCM), Healthcare Revenue Billing, Accounts Receivable (A/R), Accountable Care Organizations (ACOs), Affordable Care Act

Healthcare Financial Professionals Seek New Ways to Rescue Revenue Cycle Management

Posted on Mon, Oct 06, 2014 @ 10:29 AM

Business pressures are forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes.Shifting payment models, new regulations and healthcare reform are forcing healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.

Most hospital CFOs and group practice managers have no choice but to look for next generation of RCM solutions in order to keep their organizations solvent. Reimbursement challenges and coping with increased self-pay volumes have driven many marginally performing healthcare organizations to the brink.

In 2014, it is predicted that changes, such as reduced reimbursements, payment reforms, accountable care organizations (ACO), ICD-10 coding transition activities, physician practice acquisitions and increased self-pay collection costs will all contribute to overall declining margins. The increase in self-pay accounts will be significant, driven the Affordable Care Act (ACA) which is going to send a huge number of newly insured patients into the healthcare delivery system. Under ACA, every U.S. citizen is required to have some form of medical insurance, or pay an opt-out fine.

Not only will physicians and hospitals be swamped by treating this new wave of patients, their infusion into the healthcare system is going to create significant financial challenges due to many of the newly insured patients having extremely high deductible insurance plans, forcing hospitals and physician groups to collect this money on their own. According to a January 2014 article in Kaiser Health News, out-of-pocket payment amounts under the ACA will range from $6,350 for individuals to $12,700 for families.

This new pressure on healthcare providers’ revenue cycles is not going away; it’s something everyone will face soon.

Tags: ICD-10, Revenue Cycle Management (RCM), Accountable Care Organizations (ACOs), Affordable Care Act, Insurance Billing Solutions

10 Steps for ICD-10 Readiness You Must Know

Posted on Tue, Jul 08, 2014 @ 09:48 AM

There have been numerous delays to the implementation of ICD-10. These delays have causeddescribe the image untold frustration, -- but they have also created opportunities for healthcare providers and the organization that serve the healthcare industry. You now have time to readjust your ICD-10 timeline preparations. As an HIM Director for many years, I am offering a plan of action that may help you be prepared for the October 2015 deadline.

Considerations for Your ICD-10 Preparation Timeline

First, don’t stop or delay your planning and preparations. You have probably already accomplished some of the tasks required to meet the transition to ICD-10.  Stay the course; keep on preparing and simply be ready early – in 2015.  

Here’s a brief outline of my plan. If you would like the complete details of this my plan, please click on the button at the end of this blog. There are a myriad of steps under each of the following major headings that you need to take to be prepared.

Outline for ICD-10 Preparations

  1. Organize YOUR ICD-10 Efforts
  2. Assess the Impact ICD-10 Will Have on Your Organization
  3. Conduct Vendor Assessments for the Support You Will Needs
  4. Contact Billing Services and Clearinghouses to Assess their Preparedness
  5. Assess Your Training Requirements
  6. Revise Internal Processes as Necessary
  7. Identify Your External Testing Needs and Dates
  8. Conduct a Risk Assessment for Areas that May Present Challenges
  9. Implement ICD-10 Coding in Your Workflow
  10. Monitor Your Accuracy – Audit, Audit, Audit

A good preparation plan will significantly reduce your risks. Any transition of this magnitude will present a huge risk to your organization. Misapplication of the new coding not only threatens lost income but an assortment of other administrative and even legal issues.  Use this new delay in the compliance date to reassess your plan and ensure that everyone in your organization is prepared.

Adopt new technologies where needed. Obsolescent technology is a burden for any healthcare organizations, and will even be more critical during the transitions to ICD-10 Technology has a short lifespan and new technologies, such as computer-assisted coding (CAC) are being perfected every day. There are also staff support services that can augment your staff’s expertise during this transition. Avail yourself to every possible avenue of assistance during the transition, and most importantly – BE PREPARED!

For my complete plan click here.

 

Let's Talk About ICD-10

 

- Stacy Swartz, RHIA, CCS, CPC 

Tags: ICD-10, Health Information Management (HIM)

The Importance of Physician Champions in the Transition to ICD-10

Posted on Wed, Jun 11, 2014 @ 11:20 AM

Do you have a "physician champion"? You should. A physician champion who will support your clinical documentation improvement (CDI) program and communicate the importance of an

integratedcare

ICD-10 CDI program to his or her peers will go a long way in ensuring the success of your transition to ICD-10 in October of 2015.

Providers are now keenly aware of the ICD-10 billing requirements for claims beginning October 1, 2015. There has been, and rightly so, significant concern within the healthcare industry about the financial risks that will be incurred in the transition process, including the fact that utilization of the wrong code may result in reduced reimbursement or total rejection of a claim. Some have called this change the biggest challenge to face healthcare providers since Medicare came into being in the 1960s.

Much has been written about how to prepare for ICD-10. The emphasis has been on training the medical billing staffs and coders on how to make the transition from the 13,000 ICD-9 codes to the 69,000 ICD-10 codes. Unfortunately, there hasn’t been as much time spent or resources expended on physician education and support for the upcoming conversion. Physicians need to understand how important it is for them to properly document their care in order for coders and billers to be able to fulfill their important roles in the new billing scheme.

A report in the May 10, 2014 HIT Consultant e-Newsletter stated that 44 percent of physicians were uncertain whether or not they would have been ready for the October 2014 deadline, according to the 2014 Practice Profitability Index (PPI). In fact, another 25 percent were certain they would not have been prepared to face the transition and the ICD-10 upgrade costs.

Hospitals and medical practice groups of all sizes should be focusing on physicians and their documentation of patient care as a major aspect of how to prepare for ICD-10. Experts recommend that each healthcare entity select an ICD-10 champion from within their current staff. If possible, there should be a champion from each specialty area in a multi-specialty practice or a hospital’s medical staff in order to concentrate on how to prepare for ICD-10 within that specific area of medicine. 

Champions should be trained in the codes for their specialty area and documentation requirements to support the billing codes. They need to be willing to convey to their peers thevalue of the documentation and how it relates to proper reimbursement.

Physicians respond best when other physicians are the ones educating them on how to improve their documentation.  They are not interested in codes, but are primarily interested in providing the highest level of patient care possible. Champions can convey to their peers the connection between ICD-10 codes and how more specific documentation can improve patient care. With emphasis on patient care instead of coding, physicians will be more receptive to the change.

Champions can increase motivation of providers by emphasizing the positives of the new system, including more timely and accurate payments, fewer claim denials or returns for more information and improved patient care based on the documentation. A physician champion can engage their peers into viewing the new ICD-10 codes as management tools for improving patient care, instead of simply a burdensome bureaucratic requirement for getting paid.

Having a physician champion on your ICD-10 team will make your transition efforts easier and more successful.

Tags: ICD-10, Clinical Documentation Improvement (CDI)

How CDI Can Improve Your Cash Flow

Posted on Wed, May 28, 2014 @ 09:01 AM

The switch to ICD-10 is delayed, but not abated. With the new implementation date of OctoberIncrease cash flow 1, 2015 will your organization be ready for the best possible transition? The best place to start is by analyzing your clinical documentation improvement (CDI) program to determine the quality of documentation. Consider using you coder and case managers to identify educational opportunities for physicians and areas for improvement. Specifically, enlist the assistance of your case managers to focus on documentation trends across the board, and work with physicians who are your largest admitters.

Documentation improvement initiatives can be conducted parallel to coder education for ICD-10 preparation. Throughout the next 12 months, conduct coder gap analyses to determine strengths and weaknesses. Coders will need deep knowledge in anatomy and physiology, medical terminology, pathophysiology, and pharmacology. Your case managers should also be included in this assessment.

Multiple new mandates, including ICD-10, RAC, Medical Necessity and pay-for-performance are making accurate clinical documentation more important than ever, and the growth in volumes resulting from the ACA are impacting all organizations. Your ability to get reimbursed is directly dependent on the quality of your clinical documentation. As you are well aware, missing, poor, or non-specific clinical documentation will result in lost revenue.

You can be prepared to mitigate this loss by engaging professional CDI specialists. These professionals are credentialed, highly-trained, and they can ensure your documentation is ready for the transition to ICD-10.  Whether you use these CDI professionals to assess your program or supplement your staff, they can help you develop, improve, and maintain your clinical documentation. They can quickly get you “up to speed” with the interim or permanent CDI professionals you need. These highly skilled and experienced CDI professionals can fit seamlessly into your current program. 

Tags: ICD-10, Clinical Documentation Improvement (CDI)

The Key To A Good Night's Rest...

Posted on Wed, May 21, 2014 @ 06:23 AM

Good Sleep PhotoNow that the transition date for ICD-10 has been finalized – again! Don’t let concerns about severe reductions, or even the complete stoppage of your revenue stream caused by potential ICD-10 coding errors and slowdowns in your coding productivity keep you awake at night.

There are reasons to be concerned, but proper preparations can assuage them. Early ICD-10 test results reported in Becker’s Hospital Review from data gathered by HIMSS and WEDI indicate that only 63% of ICD-10 documentation was accurately coded.   In addition, coders averaged only two medical records per hour, compared with four per hour under ICD-9, which equates to a 50 percent drop in productivity.

There is hope and a good night’s rest – if you are prepared!

CMS officials are saying that good preparation and planning can keep providers’ accounts receivable from shutting down completely during the transition to ICD-10. The agency knows there are going to be claim denials, but they also contend there are ways to avoid many of them.

Include CMS policies in your plan. To deal with this critical change management, select a key person within your organization to be in charge of your ICD-10 staff training and education well in advance of the transition deadline.

Education on ICD-10 is going to be critical. Specialty associations, such as AHIMA, AMA, MGMA, HIMSS and several billing associations will be offering training programs and information. Take advantage of these opportunities. Every organization is going to need extensive education and training. The learning curve is going to be tremendous. Targeted, online educational programs that your staff members can access any place they have Internet availability will impact their daily productivity the least.

Industry webinars sponsored by various associations will focus on specific aspects of the ICD-10 transition. Monitor the topics of these webinars and ensure your staff members attend the appropriate ones. In addition, make sure the educational opportunities your staff attends are led and designed by true industry subject matter experts. There are going to be many educational opportunities offered in the next six month – select the ones that will provide your organization with the most return for time expended. If you select a customized educational program, ensure it is designed to maximize content retention, while minimizing interruptions to your staffing productivity.

What’s your take on ICD-10 education and training? We would like to hear from you.

Tags: ICD-10, Clinical Documentation Improvement (CDI)

How ICD-10 Can Lead To An Improvement In Patient Care

Posted on Thu, May 15, 2014 @ 07:33 AM

Doctor CoverFor all the negative press ICD-10 has gotten over the past few years, it has the potential to have a tremendously positive impact on the quality of patient care. The new system will require more accurate clinical documentation, increase the amount of data collected, improve quality measurements, streamline claims processing, and ultimately improve the quality of care provided to patients.

The new implementation date of ICD-10 October 1, 2015 will be important because it will provide updated terminology and increased specificity in a variety of areas, which ICD-9 does not currently provide. Most critical is the need to replace the ICD-9 procedure classification, which is outdated, can no longer be expanded, and is unable to keep pace with advances in medicine or medical technology, as well as demands for increasingly detailed healthcare data.

In addition, the enhanced specificity of ICD-10 provides assistance with delineating clinical populations. The expanded codes more effectively capture data about signs, symptoms, risk factors, time frames, laterality (left vs. right), complications, and comorbidities. The system also differentiates body types, procedure types, surgical approaches, and devices used in treatments.

The implementation of ICD-10 offers many quality benefits. The additional granularity of data collection and detail will require improved clinical documentation and care decisions, facilitate ongoing performance improvement, enhance evaluations of population health, and enable comparisons across the continuum of care.

The transition to ICD-10 in 2015 presents a perfect opportunity to establish a clinical documentation improvement (CDI) process at your facility, if you do not have one underway already. Following are some areas on which to focus your CDI:

Laterality: A renewed emphasis on laterality within documentation under ICD-10 is intended to enhance communication between providers as they formulate each patient’s story; all of the complexities and factors affecting the care of the patient are expected to be recorded. The goal is to improve the quality of care provided to the patient.

Disease pathophysiology: Disease pathophysiology, or the study of ongoing changes in the disease state, is much more detailed in the ICD-10 disease descriptions. Documentation must reflect the highest level of known pathophysiology for diseases so that CDI specialists can identify the most accurate level of severity.

Combination codes: Combination codes have been created to merge two diagnoses that typically are related to one another. In ICD-10, this means some codes now have six options, whereas they had one or two options previously under ICD-9.

Encounter timing: ICD-10-CM requires documentation of the type of treatment that is rendered for specific conditions, such as injuries, signs and symptoms, and external causes of morbidity. Stage of care is also a critical element of this documentation.

Identification of trimester in ICD-10: For obstetrics clinicians, new definitions of trimesters have been introduced. In addition, each episode of care must be reported along with the patient’s trimester.

Increased disease specificity: ICD-10-CM has expanded many code descriptions to connect complications and manifestations with conditions.

Alcohol and drug abuse: ICD-10 has clarified the way alcohol and drug abuse and dependence should be documented to mitigate confusion when attempting to accurately represent the patient’s condition. This will include effects, aspects, and manifestations of substance abuse.

Expansion of injury codes: Documentation of the sites and types of injuries will be required in ICD-10.

Post-procedural disorders: ICD-10-CM requires documentation to indicate if a condition or disorder is caused by or follows a procedure. Every physician needs to clearly state if a procedure caused a negative impact to a patient’s condition.

Documentation practices will be the primary driver for success in ICD-10. There will be significant changes required in clinical documentation, specifically in the areas of disease specificity, anatomical site and laterality, complication and manifestations, obstetrics, and correct use of medical terminology and naming. Providers must adhere to these changes to increase the specificity of the codes as well as decrease the potential for coding errors and unpaid claims that could impact reimbursement or quality of care.

Training is the key to preparedness for ICD-10 in 2015. Training your clinicians and providers on the code specificity is the first critical step in preparing for this transition. Your education programs should be well underway to ensure that your staff members are educated on the appropriate anatomy, physiology, and level of ICD-10-CM/PCS training required for each member’s role and work setting. October 2015 will be here before you know it!

 

Tags: ICD-10, Clinical Documentation Improvement (CDI)

ICD-10, Dual Coding - What Now?

Posted on Mon, May 12, 2014 @ 12:49 PM

The delay in ICD-10 adoption has left industry leaders in a land of uncertainty. It is now a month later and the health care circuit remains abuzz with the billion dollar question:

Do we proceed with our project plan, or do we discontinue our efforts?

The answer lies somewhere in the middle. Your organization may not need your programs to move forward with the same urgency as before the delay was announced, but discontinuing your efforts entirely has the potential to negatively impact the success of your organization’s 2015 implementation. A prudent approach would take advantage of the delay and alter your project plan to allow more time for planning, preparation, testing, and dual coding. This will enable your organization to better understand the impact this transition will have on the stability of your revenue cycle. As the current delay attests, this isn't a matter of clairvoyance—no one can accurately predict the future. It is, however, a matter of risk assessment, and of intelligently embracing the resources available to mitigate that risk. It's about how to best prepare your organizations for this momentous conversion when it finally does arrive.

If you haven’t begun already, you must evaluate the potential effect the new classification system will have on your revenue cycle. Specifically, you must understand the impact on productivity, reimbursement, and non-specific documentation and what the implications are for your bottom line.

One of the most important and valuable tools available in undertaking this evaluation is Dual Coding. Not to be confused with double coding, this is the process by which the coder assigns both ICD-9 and ICD-10 codes simultaneously. Unfortunately, Dual Coding is something of a gray area that is often misunderstood or ignored, when in reality, the the early adoption of Dual Coding can help you to capitalize on some of the benefits to be gained from its inception. Those benefits include:

  1. Analysis of provider documentation and identification of areas of risk: This provides a clear picture of which providers require additional education, and which providers could serve as physician champions to support areas of opportunity;
  2. Assessment of ICD-10 coding quality: This enables your organization to identify the need for concurrent education;
  3. The ability to provide real time data and explicit direction to the clinical documentation improvement (CDI) staff: This awards the opportunity of one-on-one provider and disease focused educational sessions;
  4. Execution of time studies: This enables you to better prepare for your specific organizational needs through analysis of real time data and actual productivity metrics, rather than planning ICD-10 go-live support staff based on another organization's time study;
  5. Testing claims with insurance carriers as early as their systems permit: This offers the opportunity to identify and correct claim submission errors prior go-live.

Early adopters of the Dual Coding initiative are better positioned for the transition, in that their system risks have been identified and mitigated. Coding quality has been assessed, areas of opportunity have been addressed, provider documentation deficiencies have been identified, and educational platforms have been constructed to tackle documentation insufficiencies as they arise. Most importantly, coder and provider productivity deficits have been addressed, and efficient go-live staffing modules have been created based upon the facts gathered from in-house data. This is far preferable to utilizing data from another organization, which may contain information that has been less rigorously obtained.

So, where do you begin? What’s the best approach to ensuring that your facilities are ready when the switch is flipped? Here are a few suggestions:

  1. Begin immediately. Once coder education has been completed, implement the dual coding initiative. There are many avenues to choose from, so simply pick what works best for your organization. Is it beneficial for all of your coders to dual code? If so, how many records? All of them ? A subset? A dedicated number on a weekly basis? Or, would it be best if your team was split in half and rotated dual coding on a weekly basis? Whatever method you choose, stick to the plan. Discuss challenges. What obstacles did you encounter? How accurate was the provider’s documentation? Were there any codes that you couldn’t assign because of insufficient documentation? If you have a Clinical Documentation Improvement team, include them in your discussions. Learn from each other.
  2. Dual Coding alone isn't sufficient. Initiate Dual Coding audits to evaluate accuracy, documentation patterns, and other areas of opportunity for improvement.
  3. Use your data! Begin developing educational modules immediately. Develop process improvement programs for your staff and re-educate as necessary.
  4. Develop Software. Work with your IT team to develop an analytical software tool that will assist you with your risk assessment. Begin analyzing your information by specialty, physician, coder, MS-DRG, etc.
  5. Most importantly, practice, practice, practice. Remember, “There is no glory in practice, but without practice, there is no glory.”

Dual coding is a valuable tool to assist in mitigating the risks assosicated with ICD-10 conversion. It makes sense to use the delay to implement Dual Coding in your organization. You'll see the benefits immediately, and when the transition date finally arrives.

Tags: ICD-10

The Unknown Unknowns: What you don’t know can hurt you!

Posted on Tue, Apr 22, 2014 @ 08:00 AM

This is a first in a series blogs that we believe presents an excellent strategic approach forself assessment achieving every healthcare provider’s end-goal during the transition to ICD-10 -- ensuring there is NO reduction or stoppage of their revenue stream. Our mission is to see a stronger U.S. healthcare delivery system come out of this momentous transition.

Conduct knowledge gap assessments

This blog deals with how to develop and execute a strategic plan of action, and the first step in that plan is to assess the knowledge gaps in your clinical, administrative and coding staffs. What you don’t know can hurt you during this transition. The specific impacts of ICD-10 are hard to identify, but it is anticipated that due to multiple technical and clinical system interdependencies these impact will be very involved and serious.

The new code set is designed to provide benefits to patients, payers and providers, such as enhanced tracking and trending of diseases, innovations in payment design and contracting, improved care coordination, more effective case management and improved utilization management. These benefits come at the price of an increase in the number and specificity of diagnosis codes. The added complexity is evident in the increased specificity in coding injuries, additional codes for laterality and emphasis on affected body systems. Coders who are light on anatomy and physiology knowledge will have an increased learning curve adapting to ICD-10.

Organizations should perform a knowledge gap assessment as soon as possible and establish a training timeline to address how their staff members will handle the impact of the greatly expanded number of diagnosis codes in ICD-10. An effective “hands-on” staff training program should be started immediately.

Multiple programs will be affected by ICD-10

Almost every ongoing healthcare project will be affected by ICD-10. ARRA HITECH’s Stage 2 Meaningful Use requirements will be affected by ICD-10’s new data and specificity requirements. CMS will no doubt push healthcare providers to use ICD-10’s new codes in their efforts to prepare for future value-based reimbursement and accountable care programs.

Additionally, Clinical Documentation Improvement (CDI) initiatives will be affected. The best way for providers to assess the impact ICD-10 will have on this program is by analyzing their present CDI program. The key is adequate and relevant documentation. Documentation improvement initiatives can be conducted in conjunction with coder education in ICD-10-CM preparation. Documentation improvement will be the driver in successful integration of ICD-10-CM and will be less challenging with greater preparation. (We will have a specific blog later on the importance of CDI)

Estimate the potential for loss of coding productivity

Coding productivity losses are estimated at anywhere from ten to 70 percent as suggested by industry pundits. Your organization should start a coding health assessment by selecting an experienced coder, preferably with medium to strong clinical knowledge to code randomly selected cases with both ICD-9 and ICD-10 systems. Run the test for a period of approximately 30 days to gather data across a representative service and case mix. Measure the initial production patterns at the beginning stages of the pilot period and at the end. Identify the learning period, and as the coder reaches stable and familiar state see what he or she can optimally produce. Use these results to plan contingencies for interim coding support and long-term staffing changes.

Conclusion

There are three key preparation issues that if addressed properly, can help providers cope with the challenges of ICD-10:  knowing their practice service patterns, assessing their staff’s knowledge, and determining training needs. Being keenly aware of their practice operations, will allow providers to determine the top 80 percent of the ICD-9 codes they presently use, from this information they can devise cross-walks which will significantly reduce the ICD-10 conversion hassle. Providers should analyze their most frequently denied ICD-9 codes. Understanding these frequently denied -9 codes, will create a reference point from which to monitor similar codes in the new ICD-10 code set. Assessing staff knowledge -- coders, billing editors, denial resolution teams – will allow providers to benchmark the training needs for these critical positions. Remember, what you don’t know can hurt you!

Stay tuned -- next up – Dual Coding!

Tags: ICD-10, Revenue Cycle Management (RCM)

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