Medical Coding Outsourcing Supports Clinical Documentation Improvement and ICD-10 Compliance

by Outsource Strategies International Medical Billing Company

A 2016 Black Book Market Research survey reported that up to 90 percent of hospitals in the US received appropriate and timely revenue and reimbursements following the implementation of clinical documentation improvement (CDI) programs. It also found that nearly a quarter of all US hospitals rely on medical coding outsourcing to meet their revenue cycle and documentation goals.

ICD-10 and Specificity in Clinical Documentation

Providers have come to realize that CDI is a high priority for success in ICD-10 implementation. According to a Health System Management report, CDI has risen to the top of providers’ 2017 budget priorities. ICD-10 requires physicians to document with greater specificity. Failing to do so will damage practice productivity as providers will end up spending more time answering medical coders’ queries on clinical documentation. Medical claims submitted without proper documentation will be denied. The American Health Information Management Association (AHIMA) suggests that coders query physicians if clinical documentation:

Is conflicting, imprecise, incomplete, illegible, ambiguous or inconsistent
Describes clinical indicators that do not clearly support the underlying diagnosis
Includes clinical indicators, evaluation, and/or treatment that do not seem related to any medical condition or procedure
Does not support or validate a diagnosis
Does not support the present on admission indicator

Such specificity is crucial for success with ICD-10 implementation. The medical coding services provided by reliable outsourcing companies help practices implement CDI solutions for appropriate reimbursements from private and government payers, and avoid costly penalties for non-compliance with ICD-10 guidelines. Other reasons why CDI is crucial:

-    CDI is necessary for compliance with regulatory, financial and operational aspects
-    CDI greatly improves the operational efficiency of healthcare organizations
-    Not paying proper attention to documentation processes will increase error rates, leading to financial losses
-    Flaws in clinical documentation affect patient care
-    Improved compliance will free up time for patient care
-    CDI improves clinical collaboration for patient evaluation, diagnosis, and treatment

While experienced medical coders in established medical coding companies can assign the right ICD-10 codes, physicians need to focus on specificity in diagnosis documentation. Accurate documentation will allow coded data to be utilized to make meaningful decisions about patient treatment and care plans. This in turn, will improve reimbursements for physicians and prevent denials and penalties.

Need for Continual Training in CDI and ICD-10

The implementation of ICD-10 calls for CDI expertise to ensure accurate and complete data capture in medical records. There are 1,900 new ICD-10-CM codes proposed for the October 2017 release, including 313 deletions and 351 revised codes. In addition to capturing new information, documentation will need to be updated, modified, and expanded. This must be a continuing and cyclical process. Physicians, medical coders, and CDI specialists must continue training in CDI and ICD-10. By collaborating with physicians on CDI, medical coding service providers promote the availability of detailed, accurate, and higher-quality data to improve care and patient safety as well as practice reimbursement.