A Deluge of ICD-10 CM/PCS Codes is Coming to All Healthcare Facilities: What to Do?

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Jim Matthews of Nearterm Corporation offers suggestions on what hospitals can do to mitigate the impact of ICD-l0 CM/PCS, which takes effect on October 1, 2016.

Jim Matthews, Principal, Nearterm Corporation

On October 1st of this year, a deluge of over 5,000 new ICD-10 CM/PCS medical codes and other changes are coming to hospitals and clinics nationwide. The stakes are high so it is important to get it right the first time. Errors may lead to delayed or denied claims, negatively impacting the revenue cycle management process and, therefore, cash flow.

On top of that, complying with ICD-10 CM/PCS requires a substantial investment in education and technology, pushing the stakes even higher.

Below, Nearterm offers suggestions on what hospitals can do to mitigate the impact of ICD-l0 CM/PCS. The big one is to create a Plan of Action (POA) to uncover and address shortfalls and unpreparedness in all RCM functional areas.

HIM MANAGEMENT
Develop a POA. Determine the level of quality and sufficiency in current coding and documentation processes by doing a formal discovery and assessment. Research might reveal that a Clinical Documentation Improvement (CDI) program is needed or should be enhanced. All relevant Changes to Practice Work Flow and Business Processes should be covered in the POA.

MEDICAL CODING & CDI

  • Ensure all Coders and CDI specialists are trained on the new/revised codes and how they may impact current business.
  • Update CDI and Coding policies to include directives on the new codes if applicable.
  • Follow up weekly with Coders and CDI specialists to discuss specific code sets/procedures that may require updating current Queries.
  • Ensure that you have a point person assigned to regularly check coding for quality.

PHYSICIANS & PRACTITIONERS

  • Physicians must be vigilant and ensure that all documentation remains at a high level of specificity.
  • For high impact surgeries and diagnoses, complete a 5-to 10-chart/ provider documentation review to ensure the documentation supports the highest level of specificity.
  • Include the physicians and practitioners in the audit results and provide education on documentation opportunities that support the severity of illness of their patients.

BILLERS

  • Billers should also become familiar with expanded ICD-10 code sets for the specialty for which they bill.
  • There will likely be snafus related to reimbursements. How to create referrals and order services IS going to change. Effective October 1, 2016, Medicare will no longer accept unspecified codes for Part B. Have the POA include ways to prevent these accounts from being billed before a second level coding review can be done.

OUTPATIENT
In the outpatient hospital side, queries may have to be sent back to the ordering provider requesting specificity either before the patient is seen (at registration) or at the time of coding for final billing.

VENDORS
Do not forget to make sure that vendors are up to date and ready for the expanded codes on October 1, 2016.

ABOUT NEARTERM
Established in 1997, Nearterm is an employee-owned, professional managed services company providing expert revenue cycle management (RCM) and financial management services to hospitals and healthcare organizations nationwide.

Nearterm specializes in the delivery of additional “horsepower” for implementing and supporting RCM activities and projects. These resources can work from remote locations and/or onsite, whatever hospital and the POA requires of them. Nearterm delivers only top notch talent:

  • Consulting (Discovery, Research, Analysis, Planning, POA, Implementation Support
  • Leadership (VP, Director, Manager, Supervisor, Team Leader)
  • Technicians (AR Specialists, Coders)

Nearterm is a recognized authority in Revenue Cycle Management

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Jim Matthews
Nearterm Corporation

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