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ICD-10 is Here, What Now?

The ICD-10 frenzy is underway. Practices are busy ensuring that documentation contains the necessary level of specificity to ensure appropriate coding. Office staff is trained and their coding tools are ready for use. Systems have been checked and are ready for the conversion, and everyone is looking forward to October 1, 2015. Unfortunately, the transition work does not stop there. Monitoring your ICD-10 workflows should continue for several months.

We Don’t Know What We Don’t Know

Practices must have a plan to ensure training does not stop on October 1st. Regular use of ICD-10 codes will result in questions that need clarifying and situations that need guidance. Resources should be identified to ensure no disruption in the workflow. Create partnerships with your peers, with consultants or with specialty societies to assist in getting these newly discovered questions answered.

In addition, make sure someone from your practice is monitoring payer policies, including Medicare National and Local Coverage Decisions. If codes are missing contact the payers and request to have the policy reviewed.

Continue to perform internal audits on documentation and claims. From a documentation standpoint, make the changes necessary to use the most specific ICD-10 code, keeping in mind that this may necessitate changes in your EHR templates. Periodically reviewing your claims before they are sent to insurance will allow you to measure the accuracy of your current workflows. Pay close attention to the linking of charges and diagnosis to ensure your systems are working properly.

Everything May Not Be As It Seems

Even though payers are receiving and processing your claims, measures must be in place to ensure appropriate payments are being received by your practice. Two critical areas to monitor are payments and denials.

Payments: As payments arrive to your office, review the explanation of benefits to ensure you are getting paid at the proper rate based on your contract. Monitoring payment levels will confirm that the payers are not having any system issues due to the conversion. Incorrect contracted payments are a common cause of revenue leakage.

Denials: Monitoring zero pays and denials is the best defense to identify claim problems. This could be the first indication of an ICD-10 issue. Review each denial remark code to understand why no payment was received and determine if it is a payer issue or practice issue. Fix practice problems as soon as possible to get claim payments back on track. Work with payers collaboratively on issues identified as theirs.

If your revenue appears to be lagging but payments are appropriate and denials are not abnormal, talk with practice staff to ensure there are no backlogs of work or black holes in the work processes. Create a contingency plan to assist in addressing any identified issues. The sooner payers receive clean claims, the sooner your revenue will return to normal levels.

Communication Is Key

Keep an open line of communication with your office team. Determine what processes are working and which ones are not. Monitor productivity to measure the effects of ICD-10 and formalize processes to assist in normalizing the workflows. Providers must complete queries and addendum requests in a timely manner to assure no disruption in the work, keeping in mind that the ICD-10 codes submitted for payment must be supported within the documentation. Ask and answer questions. You cannot fix something you are now aware of!

Challenge Vendors

As you identify items that would enhance your work processes, talk with your vendors to see if they can provide it for you, especially in regards to your electronic health record. In most cases, I would venture to say you are not the only ones asking! Try not to create workarounds that have the potential to cause more work in the long run.

It is recognized that practices have put a lot of time, effort and money into their preparation for ICD-10. Don’t stop there; continue that effort after October 1, 2015. Getting questions answered, monitoring payments and denials, opening the lines of communication and, as needed, holding discussions with your vendors will assist your practice with continued efficient workflows.

It won’t be long before ICD-10 is the new normal, and putting post implementation monitoring in place now will help ensure the transition is a smooth one.

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