Preparing for ICD-10
By Ric Sinclair, Head of Product, ZirMed
Twitter: @Zirmed
ICD-10 is often described in scary terms—a potential disaster, a perfect storm, an angry attacker bent on destroying your practice.
OK, maybe not that last one. But as you ready your organization for ICD-10, consider applying some of the principles of Krav Maga—a martial art focused on preparing for real-world situations and minimizing the harm that can be inflicted on you.
Train for real-world scenarios
Focusing on your “top codes” is important—but it’s only one component of reality-based training and preparations. A real-world scenario encompasses every aspect of the billing process for your organization’s most common, most impactful diagnoses and procedures from start to finish—from developing clinical documentation to coding claims based on that documentation to submitting the claims through your clearinghouse and correcting any errors before the claims are submitted to payers.
Create at least some of your test claims using this same process—your coders should work from relevant samples of your current clinical documentation and natively code the claims in ICD-10. This will help them become accustomed to everything from the “feel” of inputting new codes to the level of detail needed to support the increased specificity of ICD-10.
It will also reveal exactly where clinical documentation is lacking. Are physicians forgetting to note laterality? Are they remembering to record the trimester for every pregnant patient regardless of the reason for that patient’s visit? Once you have this information, you can create a clinical documentation checklist or form tailored to the areas where they need to improve.
Go on the offensive against denials and your average A/R days
It’s easy to feel overwhelmed and even powerless in the face of sweeping change—but you can make moves right now to get the upper hand and improve your organization’s overall financial fitness:
- Attack ineligibility—it causes more than 75 percent of all claim rejections and denials by payers. Implement a cost-effective, user-friendly solution for checking patient eligibility. You’ll not only reduce denials now, you’ll have less “noise” to sort through when you’re working to identify and drive down ICD-10-related denials post go-live.
- Strike where your impact is likely to produce the most dramatic results. The first step is identifying the targets—and to do that, you need a revenue analytics solution that enables you to drill down into the accounts receivable (A/R) details for each of your major payers. Is it taking you longer to get claims out the door for one particular payer? Is your largest payer the slowest to respond to claims? And if so, what is the potential ROI on dedicating some of your coding resources specifically to that payer? These answers will show you where to strike next.
Your A/R days may still rise in the months immediately following October 1—but the increase will be tacked onto a lower initial number, reducing the scale of the overall impact.
Be hyper-aware of your surroundings—for danger and opportunity
Mindfully monitoring the events and changes in the ICD-10 landscape reduces the likelihood of being caught off guard—and helps ensure that you don’t miss opportunities such as one-time testing initiatives with specific payers.
Read up on the results of the first Medicare testing week. Stay current on the testing status of your major payers. And find a reliable source for the latest ICD-10 and industry news to alert you to developments up ahead.
And of course, there’s another Krav-Maga-related aspect of ICD-10—what code indicates the circumstances of an injury involve martial arts?
Y93.75—not to be confused with Y93.74, which applies to injuries associated with ultimate Frisbee.
That actually touches on a serious point. As you seek a vendor ready to help you train for real-world scenarios—a partner that’s equipped to help you go on the offensive against denials and A/R days, and poised to help you take advantage of testing with Medicare and other payers—look for one other attribute too: user-friendly solutions that help you pin down the right code.
Ric Sinclair is the head of product at ZirMed, a leading health information connectivity and management solutions company. In his role, Ric leads all aspects of product direction, management, design, and development.