September 21, 2015
Johnson Price Sprinkle PA Shareholder and Vice President of Healthcare Services, Mary P. Williams, CPA, CMPE, has an active schedule presenting on current changes in healthcare.
Mary has already spoken to groups in Wilkesboro and Asheville, NC. Her next presentation will be on Monday, October 5 at WCMS Independent Physicians Affinity Group.
At a recent WCMS Association board meeting, Mary provided some of the following information regarding ICD-10 Transition and Implementation:
1. Implementation date is October 1, 2015, with no “soft” transition or further delays possible.
2. The move to ICD-10 is not merely an update to ICD–9. It involves significant structural changes to the coding system, with increased complexity that involves the coders, physicians and billing staff in the practice.
3. Anatomic site, laterality and phase of encounter with the patient will all now be captured in ICD-10 codes.
4. Codes will be alpha-numeric, rather than numeric only.
5. Documentation will be required to match coding, or in the case where coders other than the physicians are utilized, making sure the encounter is properly documented so that the coder can assign the correct ICD-10 code(s) to the medical record.
Sample current records and assess the documentation located there for readiness to meet more specific ICD-10 standards.
Practice with the new code sets. Keep in mind that more documentation is better than less. When in doubt, write it down.
Have brainstorming session with coders and physicians to determine where significant impediments can occur.
Once implementation has begun, monitor claim denials due to incomplete documentation and implement a process for retraining/feedback to coders.
Documentation concurrent with the encounter is going to become more important than ever. Recalling specifics of an encounter with a patient at the beginning of the day is going to be very difficult at the end of the day using lCD-10 standards.
Don’t forget that scheduling/authorizations staff will need to be included in training, since their work will be affected by the transition as well.
Create new superbills, if still using paper to move patient through the office.
ICD‐9 will still be utilized by some payers (e.g. worker’s comp).
Utilize crosswalks established in most electronic health records systems to move diagnosis code from ICD‐9 to ICD‐10. Get familiar with search tools in thesystem that will facilitate correct expanded coding capabilities.
Identify top 20% of ICD‐9 codes used by each provider in the practice. Document these codes on 3 x 5 index cards, with associated ICD‐10 coding needs side by side. Physician can keep these cards in their pockets – a quick visual reminder of coding requirements, or documentation needs, if they are not performing their own coding.
Allow for the demands on the practice’s revenue cycle that ICD‐10 will impose
May slow down providers as they become accustomed to new codes; consider physician schedules with fewer patients in the first few weeks.
Clearinghouses and payers are likely to have some interface issues with the new codes; this could slow down reimbursement even for “clean claims” submitted.
Claims denied due to lack of sufficient coding specificity could also create reimbursement delays. Make sure billers/collections staff understands the new coding sets.
Assess the practice’s line of credit availability in order to be able to fund practice overhead, should denials and IT delays create a cashflow shortage. Meet with practice banker to make plans to increase line of credit if needed.
For assistance: Resources available through American Association of Professional Coders (AAPC.com); American Health Information Management Association (AHIMA.org); or Carolinas Center for Medical Excellence (CCME.org); Workgroup for Electronic Data Interchange (WEDI.org)
The Rise of Employee Financial Responsibility/High Deductible Health Plans
Health plans with leaner benefits being chosen by patients in order to keep premium cost down.
Narrow networks are throwing patients off established physician relationships
WCMS March 11, 2015 Vital Signs newsletter article “Getting Paid in Your Practice” gives details on how to protect the practice from financial loss.
Inception of Value Driven Reimbursement
Changing reimbursement patterns by payers will change how revenue is earned by a practice, and therefore how physicians are compensated for care provided.
Ability to determine and collect data in the following areas will allow a practice to prepare for value based reimbursement:
o Cost of care
o Patient outcomes
o Clinical quality
o Patient satisfaction
Contact Mary P. Williams to discuss your medical practice needs and how JPS can assist you.