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Coding Strategies for Physicians as ICD-10 Deadline Looms

It’s about 7 and a half months away – the ICD-10 compliance date of Oct. 1. While some organizations are pushing for a two-year set-back, others are urging Congress to avoid further ICD-10 delays.

Either way, if the ICD-10 compliance date isn’t moved, physician practices need to be ready to implement the new code set. Experts recommend complete and clear documentation of each patient so that claim submissions are not delayed; practice testing by coding them both the old system and the new; and charting workflow and contingency plans.

The Progressive Physician spoke with Joshua Berman, director of Business Analytics & ICD-10 Lead, Relay Health Financial, a McKesson company, who has been responsible for RelayHealth’s plans and preparation for the ICD-10 changes impacting our industry.

Q: What steps can medical groups and physicians take now, especially in testing and training, to be prepared for the ICD-10 compliance deadline?

A: I’d highly recommend 3 steps:

  • Readiness – build a plan around getting the claim out the door. Make sure your systems are ready, your documentation is deep and detailed, and your coders are ready to code. For the last step, keep in mind that your coders probably only use 100 or so of the new codes for the majority of your business. Focus on those codes. Don’t let the daunting number of codes get in the way of perfecting the system around the codes you use.
  • Test – test where you can. If you can’t test, ask the payers to be transparent in their other testing results. You can learn from their other testing. We all understand testing is limited to the resources payers can provide, but sharing that information can help everyone.
  • Go Live Preparation – if you aren’t tracking and benchmarking your performance, start to do so now. For example, make sure you know your denial rate and the cause of those denials; understand how long it takes to get a claim out the door; and have a grasp on the amount of time it takes to get remittance from your payers. Create initiatives to improve those metrics now, thus reducing the impact of any failures resulting from ICD10 glitches after 10/1/15. Also, once you have those metrics and benchmarks, make sure you track them through 10/1/15 and after.

Q: What obstacles or possible setbacks might care providers encounter while preparing for ICD-10?

A: I am personally worried that the most simplistic processes are not going to be completed. The largest obstacle will likely be the lack of simple preparation. Everyone is offering advice on how to get ready and it may be easy to get distracted from what really matters. Try to keep your plans and preparation efforts focused on the processes and contributing factors that impact payment. When you boil it down, that is what is probably keeping you up at night.

Q: What resources are available for care providers?

A: There are some fantastic pieces and recommendations on the web, including products such as RelayHealth Financial Diagnostics and free websites such as CMS/Medicare’s Additionally, call on those vendors you are used to working with. Many began to attack ICD-10 many months or years ago, and have a great perspective on the ICD-10 transition.

Q: What will healthcare most likely look like after ICD-10 is implemented?

A: After the dust settles, it will be the same, just with more data available for analysis!!! It is crucial we catch up with the rest of the world in this area. ICD-10 coding will at least allow us to compare our outcomes with world mortality and morbidity rates, and ideally help hone initiatives to improve care in this country.

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