9 TIPS FOR SURVIVING AFTER THE ICD-10 GRACE PERIOD ENDS. By Aine Cryts

Transcription

1 9 TIPS FOR SURVIVING AFTER THE ICD-10 GRACE PERIOD ENDS By Aine Cryts

2 BE SPECIFIC IN YOUR CODING "Specificity in documentation and diagnosis coding since the ICD-10 implementation is to be encouraged. While [CMS] allowed unspecific codes, this wasn't supported by other payers or by payer policies. Keep in mind that documentation is used for more than billing. From a continuity of care and a risk management standpoint, documenting to the highest specificity is in the best interest of all providers." --Ann Bina, CPC, vice president of compliance fulfillment at West Salem, Wis.-based Compliance Specialists

3 KEEP AN EYE ON DENIAL TRENDS "Practices should continue to monitor both denials and account receivable unpaid charges to ensure there are no issues with claims and receiving payment. A denial trend is often the first sign that something is wrong with your claims." --Ann Bina

4 REVIEW EHR- AND BILLING SYSTEM-BASED CODE CHOICES "It's good practice to review the code choices in your EHR and/or billing system to ensure the most specific codes are available as code choices. I recently worked with a provider who had an incomplete code file and could not get his claims through the clearinghouse edits. Correcting the file was a very frustrating process for the practice!" --Ann Bina

5 NEW CODES ARE ON THE HORIZON "Keep in mind that [the grace period] was only for CMS and if there was already a [National Coverage Determinations] or [Local Coverage Determinations] in place, there was no grace period; those edits still triggered denials, so those were already worked out. I'm feeling confident that practices will do OK. That being said, we're coming out of the code set freeze and will have to work [more than] 1,400 new codes into our daily routines." -- Rhonda Buckholtz, CPC, vice president of strategic development at Salt Lake City, Utah-based AAPC

6 FOCUS ON THE MOST RELEVANT CODES "Practices should take a look at what changes are specific to the conditions they treat. Also, in the move toward Advance Payment Models, the data received from claim forms could factor into future payments, so we want to make sure we use the codes to the best of our abilities." -- Rhonda Buckholtz, CPC

7 ICD-10 CODES THAT FOCUS ON QUALITY INITIATIVES "We need to have a discussion about how the diagnostic codes may help shape the future of practices through quality initiatives and how vitally important it is for practices to submit clean claims utilizing the coding system to the highest level of specificity and to capture comorbid conditions in reporting when needed to demonstrate the complexity of the patient." -- Rhonda Buckholtz, CPC

8 SELLING PHYSICIANS ON BETTER DOCUMENTATION "The question we keep dodging is how to get the providers on board with all this logic [associated with ICD-10]. The road block I keep coming up against when I'm doing my best to 'sell' this concept of better documentation [and] more awareness of diagnosis coding is, 'Does this affect my payment today?' The answer is: 'Well, not directly, not today.' "There are more denials for unspecified codes. For providers who have an EHR that requires that provider to select the diagnoses code prior to the claim being filed, this is an excruciating process that takes a lot of time. How can we convince them of the urgency and the importance for the future? As a coder, I can easily see the significance. If I were the provider, I, too, would need to be sold hard on this." -- Jaci Johnson Kipreos, CPC, president of Richmond, Va.-based Practice Integrity

9 ISOLATE FREQUENCY OF UNSPECIFIC CODE ASSIGNMENT "The first step is to identify the current frequency of unspecific code assignment. For small practices, an overall view of the frequency can be reviewed. For medium-sized practices, each specialty and/or specific practice location should be reviewed and then narrowed down by individual provider. If a high frequency of unspecified codes are identified, each code-set should be reviewed to determine what more-specific codes are available for code assignment. "For small practices, this can be addressed with the provider(s) immediately. For medium-sized practices, a brief record review should be performed to identify opportunities for more specific code assignment. These results should then be shared with providers to educate them regarding the assignment of more specific codes." -- Kat Austin, CPC, director of coding and data standards at American Health Information Management Association (AHIMA)

10 UPDATE ENCOUNTER FORMS AND REFERENCE TOOLS "After identification of unspecific code assignment and subsequent education to assign more specific codes when supported by the medical documentation, the next step will be to update all encounter forms, reference tools, and diagnosis 'favorites' lists both paper- and EHR-based with diagnoses that contain more specificity. "This can be done concurrently when updating these tools with the new 2017 ICD- 10- CM codes. Also, practices will want to ensure that any [Local Coverage Determinations] or [National Coverage Determinations] associated with services they provide are reviewed since the unspecified ICD-10-CM codes may be removed as a diagnosis supporting medical necessity." -- Kat Austin, CPC