ICD-10: What now?
ICD-10 was implemented at the stroke of midnight October 1, 2015. Your claims should now be leaving your house with an ICD-10 code on them. Here are a few steps to stay focused on the impact this change is making on your practice.
- Understand the impact of clinical documentation for ICD10. Review your most frequent or high revenue conditions for your group. Once you have identified them make certain you understand the key clinical concepts that must be documented to support the specificity in the ICD10 code(s) that you have sent on your claim to a payer. Key clinical concepts include a complete understanding of reporting underlying conditions, manifestations, and adverse effect and how these concepts report the severity and risk for your patient. Watch for trends in your level of medical decision making as it relates to reporting diseases and conditions at the highest level of specificity.
- Review electronic reports after each claim batch release. Assess and repair immediately. Find out where the problem is and communicate.
- Implement a Denial Management Assessment process. Classify claim denials and requests for additional information as payments are posted. Include dollar value of the claim. Watch for trends in order to assess the reason for the denials and requests to correct issues quickly. Make certain that you are receiving the contractual fee that you are expecting. Report the dollar value of pending claims for additional information or the dollar value of denied claims at weekly provider and management meetings. Trace and fix the issues quickly.
- Make certain that your staff is trained on how to capture the documentation that supports the ICD10 code when a payer asks for records. Staff must include orders, significance of findings of diagnostic tests, and previous encounters that support the documentation of the encounter in question. Staff must be trained on assessing the documentation and the reporting of the codes and getting it out the door correct initially.
- Stay on top of system updates and upgrades. Maintain an open line of communication with your vendors regarding your system updates and upgrades. You may discover that your hardware is not able to handle system updates which will result in system upgrades. All of your systems must work in tandem with each other for optimal productivity.
- Evaluate new technology from vendors. Take advantage of system tools that will improve productivity and monitoring aspects. Assign accountability among your staff.
- Call for help when necessary. Do not wait until you are drowning or you exhausted your line of credit to stay ahead of the game.
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