Strategies for Surviving End of ICD-10 Flexibilities

by Outsource Strategies International Medical Billing Company

The ICD-10 grace period ended on October 1, 2016 and physicians need to focus on proper medical coding practices to prevent denials and make adjudication of claims quicker. They must also learn how to make ICD-10 work to improve patient care and establish medical necessity. While medical coding companies make all of this much easier to handle, here are some strategies that physicians should know about to survive end of ICD-10 flexibilities.

Make sure medical record documentation is accurate: The medical record should be complete as well as legible so that the medical coding service provider can code appropriately. Reliable coders will query the practitioner if they find that the documentation is incomplete, inconsistent or ambiguous.
Ensure specificity in coding: Every healthcare encounter should be coded to the highest level of specificity. ICD-10 codes with the correct level of specificity are now required for prepayment reviews and for preauthorization requests. Experienced coders will examine the patient’s entire medical record to determine the principal diagnosis, rather than rely only on the discharge summary or face sheet. Of course, under ICD 10, unspecified codes may be the best option to accurately reflect the health care encounter if a definitive diagnosis has not been established by the end of that encounter. However, as specificity is the key to getting paid, reliable coders will review reports of most commonly used “unspecified” ICD-10 diagnosis codes, identify trends of such code use and also assess clinical documentation to identify opportunities for more specific code assignment or improvements in documentation.
Pay attention to denial trends: Monitoring both account receivable unpaid charges and denials will help ensure that claim submission processes are working smoothly. Denials are a sign that something is wrong with the medical billing process.
Prepare for new ICD-10 codes: The Centers for Medicare and Medicaid (CMS) has released ICD-10-CM updates for FY 2017. There new codes became applicable for discharges occurring from October 1, 2016 through September 30, 2017 and for patient encounters occurring from October 1, 2016 through September 30, 2017. There are 1943 changes to ICD-10-CM codes as well as 422 revisions and 305 deletions. Practices should examine what changes are specific to the conditions they treat.
Evaluate and update EHR configuration: Well-designed EHR systems that are updated automatically when rules and policies change make it easier for medical coders to ensure accurate ICD-10 coding. Practices need to evaluate and update their EHR configuration so that it is easier to find the most specific ICD-10 code to report the patient’s condition. For instance, if the software allows selection of unspecified ICD-10 codes by default, practices should consider changing settings so that coders can choose codes offering greater specificity. All encounter forms, reference tools, and frequently diagnosed conditions lists should be updated.

Having expert medical billing and coding services can make it much easier to survive end of ICD-10 flexibilities. The experienced team in a reliable outsourcing company would have a proper understanding of the coding and claim submission process, medical insurance policies, and the appeals process. By working closely with physicians and their staff, these professionals will ensure proper documentation for the submission of clean claims by utilizing the ICD-10 coding system to the highest level of specificity.