ICD-10: Focus Your Training to Protect Your Revenue SUGGESTIONS THAT HELP YOU PREPARE IN ADVANCE OF OCTOBER 1, 2014 By Jackie Griffin It is less than one year from the ICD-10 implementation deadline. Is your company preparing your clients’ practices? Some providers may be well on their way to preparing their offices for the transition, but we know many others have yet to begin – and are dreading the process. For example, we recently surveyed over 750 providers, and more than 80 percent said that they have not begun training their coding staff for ICD-10. It seems providers everywhere are asking the same question: how do I get started? We suggest you begin by identifying every way that your clients’ practices currently use ICD-9 codes, since all of these will need to be updated for ICD-10. Once you understand which areas of your practices ICD-10 will impact, you can focus on identifying the ICD-10 codes that will be most important for you and train your staff with these new codes. Here are some steps that can help you identify your relevant ICD-10 codes and guide your training efforts: • Discover which ICD-9 codes your clients use most often today. These are the ones that account for the majority of claims and have a big impact on your revenue. • Next, determine which ICD-9 codes are used for the claims that account for the highest revenue. since these claims are responsible for your largest payments, it will be important to understand how the codes translate for ICD-10. • use a crosswalk tool, like Cms’s general equivalency mappings (gems), to identify the applicable ICD-10 codes for your commonly used ICD-9 codes. ICD-10 codes provide greater specificity for diagnoses, so there could be several ICD-10 codes that correlate to one ICD-9 code. Focus your staff training around this list of possible ICD-10 codes. • Conduct a chart assessment of claims that use your common ICD-9 codes. How much documentation did the clinical staff provide? Is it enough to assign an appropriate ICD-10 code? Coders will not be able to assign the right ICD-10 code unless the doctor or nurse provides sufficient detail when recording the patient’s condition. If the coder picks the wrong code due 30 HBma BILLINg • JaNuaRY.FeBRuaRY.2014 to a lack of documentation, your clients’ practices may not be adequately reimbursed. • get coders and clinical staff together to discuss the information needed on the patient chart. some eHR systems are adding fields and questions to their forms to prompt clinical staff members to provide these extra details for ICD-10, such as laterality or week of gestation. Billing companies may find it helpful to develop a cheat sheet of common diagnoses and the level of detail coders need for quick reference. • ask clinical staff to start documenting to this level of specificity now so it is second nature by the time ICD-10 is implemented. • many practices are evaluating dual coding for a percentage of their claims so that these can be evaluated as a training exercise. even if your practice management system does not support dual coding, you can dual code selected claims on paper and review periodically. Then when ICD-10 is required, you can all feel more confident about using the appropriate code(s). It is wise to do all this research and training now and check off a major step in your implementation plan. You will improve your coding productivity for the October 1, 2014 deadline, and your clients’ offices will be far better able to handle any payment issues. The reality is that your claims denials will likely increase as payors change their reimbursement policies to incorporate ICD-10 codes next year, but you can reduce the risk by ensuring that your staff understands how clinical documentation and accurate coding will impact your clients’ reimbursement. educating clinical and billing staff well in advance of the ICD-10 deadline will enable you to address problem areas up front and minimize payment delays. For more information about preparing for ICD-10, visit www.gatewayedi.com/icd10. Jackie Griffin is the client services director for the training and implementation teams at TriZetto Provider Solutions. Jackie also serves as the company’s ICD-10 expert, leading efforts to educate customers and the industry about ICD- 10 planning, issues and concerns. She previously managed much of Gateway EDI’s 5010 transition strategy, planning and rollout.
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