When meeting with new clinics one of the challenges often uncovered is high coding lag times, missing charges that go unaccounted for, and timely filing denials. This adds up to not getting paid for the hard work and services provided. With the ICD-10 transition these challenges have increased exponentially for some clinics.
One of the key concerns is for providers that utilize scribes or outside coding. While the physician has first hand experience of the procedure or service, the coders rely on the documented record to make their determination. With ICD-10 there are increased requires for specificity including such things as laterality, type and location related to the service. For injuries, the external cause and place of occurrence must be documented in order to code properly. This October brings a new level of scrutiny to ICD-10 coding and without proper coding claims will be denied by the payers.
Perhaps the best means to identify if current documentation will support ICD-10 coding is to have a documentation assessment. Outsource Receivables is collaborating with the AAPC (American Association of Professional Coders) to offer documentation assessment services to the over 200 providers we serve. This involves prioritization of codes by volume, frequency, and reimbursement and then collection of representative samples of 10 claims per provider that allow the greatest opportunity for meaningful feedback on the AAPC assessment. Once the documentation assessment is complete providers can review internally and then meet with an AAPC consultant to analyze the findings. The next step is to identify training needs and gaps. ORI has also coordinated a training package for practices from the front desk, to the coding team and from the providers to the leadership level. The trainings are deployed and managed via an ORI administrative portal which allows practice administrators to receive regular reports on the progress of their providers and staff.
Another wise move is to bring together your providers, scribes and coders to talk openly about common workflow challenges. Better to uncover the issues sooner than later. Staff may not always feel comfortable talking directly to the MD who consistently completes their documentation a week or two after the visit. Staff might have valuable information on how to document to the level of service so the practice can receive proper reimbursement. Likewise, providers may be able to relay their own challenges of using the EMR templates that can lead to recommendations to increase efficiency. While everyone is busy, it will almost certainly be time well spent.
ORI also facilitates on-site consultation to ensure the audits and training are on track and assess technology requirements and testing. Testing includes sample claims generation from the practice management system and clearinghouse. End-to-end testing is also being facilitated with payers that provide the opportunity.
For providers using an electronic medical records system many documentation requirements can be built into templates. ORI can work with practice EMR ‘champions’ to review templates and recommend and implement integrated EMR coding tools for ICD-10.
While “unspecified” will still be an option for ICD-10 coding going into 2017, it should only be used when no other available options exist. Having a professional documentation audit, coordinated training across the team, and technology testing get your coding to the highest level of specificity backed up the the required documentation. Keeping lag times low and communication lines open will be key to success as the transition is implemented. Lower lag times mean less chance of timely filing or missed charges.