Create a “Denial-Smart” ICD-10 Education and Implementation Plan

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Fool me once, shame on you. Fool me twice, shame on me. It’s not news that healthcare budgets are tight. The Affordable Care Act has brought more insured individuals than ever before and hopefully, has cut down on the amount of non-emergency, emergency room visits.

Regardless, denied claims can shut the door for many smaller practices. It is projected that come October 2015 when ICD-10 goes live, denied claims will go up 200% and A/R days will increase 40%. That number doesn’t even take into account the fines and penalties for noncompliance.

Still, as a whole, the healthcare industry is not training staff on ICD-10. Yes, it was delayed once, but the senate landscape is different now and October 1 is only 126 days away. You’d be better off betting on a hard six on a Vegas craps table (which is nearly impossible for those of you who don’t play craps :-0).

According to our recent ICD-10 webinar, Industry expert Linda Corley from Xtend Healthcare discussed the increased specificity of the ICD-10 code set. Using ICD-10, regardless of staff position, will require more detailed clinical documentation and understanding of the required chart specificity.

You can start by conducting medical record documentation assessment. Some suggested steps are:

  1. Understand who is documenting and coding, as well as you most commonly used codes.
  2. Follow up with educating your providers, use specific examples of the new and sometimes complicated coding set.
  3. Then, emphasize concise data capture for optimal results (maybe hire a handwriting expert in order to decode some physician’s handwriting.).

In our recent webinar many attendees were still unsure of who needs ICD-10 education. Generally, the following positions will need education:

  • Coding professionals
  • Providers
  • Billing personnel
  • Clinical personnel
  • Administrative staff
  • Management
  • Researchers

The Department of Health and Human Services (HHS) recommends inpatient hospital coders receive 50 hours of training and outpatient coders will need ten.

Here’s a quick scenario. If you intake a person on September 28, 2015 and discharge them October 3, 2015, do you know what code set to use? (Tip: ICD-9 through September 30. ICD-10 through October 3.)

It will be similar to creating two different charts for the same person, for the same stay, treating the same illness; that will require a lot of time and knowledge. Could you do that today?

One more scenario…what about pharmacy refills? If you write the prescription prior to October 1, 2015 you would use ICD-9. However, if the patient fills the prescription after October 1, you are required to update the information using ICD-10. The same will be required for lab, chemotherapy and occupation therapy.

As ICD-10 replaces ICD-9, health plans (Medicare and Medicaid) will revise their policies and procedures to create stricter reimbursement schedules to take advantage of the more detailed information being collected. All providers will need to change their processes to adapt to these changes.

Keep in mind these necessary operational steps:

  1. Update technology and assess vendor readiness.
  2. Assess payer readiness.
  3. Evaluate and update operation processes.
  4. Train physicians, coders and Revenue Cycle and Patient Financial staff.
  5. Accept this is a long-term project requiring a structured work plan.

Or, you could just go to Vegas. Your choice!