Friday, May 22, 2015

One Short Summer for ICD 10 Planning

By: Tammie Lunceford, CPC BSHA (Healthcare Advisor with Warren Averett CPAs and Advisors)

The repeal of the SGR did not include a delay in ICD 10. The medical community is now in a hurry to plan, train and budget for the ICD 9 to ICD 10 conversion which is scheduled to begin on October 1, 2015. There is no time to waste!

On February 9th, the General Accountability Office reported to the United States Senate that CMS is well prepared. End to end testing has been successful with 2,550 covered entities. Most of the tools through CMS are geared toward small or rural practices.

Since alternative payment models are evolving, implementing ICD 10 is necessary. The alternative payment models, or merit based payment models, rely on more specific coding to provide the risk adjustment details of each member to the insurance carrier. The value based modifier analyzes clinical effectiveness through PQRS reporting, and cost effectiveness through risk adjustment, to award or penalize providers.

Some physicians presume their own behavior requires little modification and they can leave it to the staff to properly code the services. Some billers believe the electronic medical record or the doctor will give them the codes to file, limiting their responsibility. Almost everyone thinks they need to understand the coding for their specialty and they don’t want to waste time with general code set training. Regardless of your belief, below are some action items:

• Choose a physician champion

• Perform a workflow analysis to devise your plan of action

• Contact vendors for readiness and preparation

• Revise paper superbills if not using electronic ones

• Train every staff member that uses diagnosis coding—not all staff need the same training

• Improve clinical documentation among all providers

• Bring coding personnel into the exam room to guide the documentation process

• Test claims with the carriers

• Work with billing staff on follow-up protocol

• Sustain revenue with a line of credit

We can find our way through this implementation if we plan appropriately. Training opportunities are available through many resources. Map a plan for your practice today, don’t delay.

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