The ICD-10 transition is going to have a big impact on virtually every aspect of a clinic’s functioning, be it clinical, administrative, or reimbursements. It is still not too late for a clinic to join hands with an able medical billing vendor to take stock of the situation and devise a strategy, such that no major hiccups are experienced in the RCM cycle when the transition happens.
Some Statistics on ICD-1O
Come Oct 1, 2014, ICD-10 will become obligatory and all clinics and hospitals will have to code in ICD-10, either after fully adopting it or utilizing cross walking mechanisms.
A survey of more than 120 hospitals found: • 40 percent have not begun ICD-10 CM training for coding staff • 55 percent have not begun ICD-10-PCS training for coding staff • 47 percent have not begun document improvement education for medical staff • 31 percent do not plan to dual code prior to Oct. 1, 2014
Although individual physicians and small practices may be faring better, as indicated by certain surveys conducted by Medicaid, it is entirely within the realms of possibility that for about 10 to 15% of the practices ICD-10 might hit them like a hurricane.
AREAS TO CONCENTRATE WHEN TRANSITIONING TO ICD-10
1. Denial Management: As payers, like everyone else, move over to ICD-10 they may be forced to modify certain criteria for prior authorizations and referrals. If the clinic is not fully aware of these changed parameters, either via the denial management team having a tab on payer reimbursements for ICD-10 coded claims, or a cross-walking mechanism, a clinic’s denial rates might spike to uncomfortable levels.
Your denial management team might benefit immensely by studying tools such as “General Equivalence Mappings” (GEMs)” developed by the CMS, which aids in the cross walking and thus can aid you in understanding the rationale behind the payer’s changed behavior patterns. GEMs can be freely downloaded at http://www.cdc.gov/nchs/icd/icd10cm.htm.
2. Auditing: As can be expected future RAC audits might focus on how compliant your clinic is with ICD-10 specificity coding. Thus before an RAC happens and finds discrepancies either you or your medical coding vendor can conduct internal audits to ensure that no rules are flouted.
3. Increased role of ICD-10 in ACOs: If your clinic is looking to join the ACO stream, like many others, then it is mandatory that you become proficient in ICD-10 usage since it will be the mandated gold standard for ACOs and will be used by CMS for disease pattern tracking and resource distribution.
4. Optimal Coding: Coding accuracies will invariably be affected due to the 5 fold increase in codes and the fact that there will be a 1-to-1 match for only approximately 25% of the codes. Rigorous monitoring of coding during the initial stages with continuing education will become mandatory if your medical coding has to reach ICD-9 accuracy levels.
The post 4 Crucial Areas to Focus On During ICD-10 Transition- INFOGRAPHICS appeared first on BillingParadise.
