Beruflich Dokumente
Kultur Dokumente
By Bess Ann Bredemeyer, BSN, RN, CHC, CPC, PCS Director of Compliance Consulting
care by indicating more precisely the diagnosis, and will better match the payment for care to the care delivered. In time, it will promote greater efficiencies in care documentation and claims processing. In some cases, providers will receive more appropriate reimbursement for complex procedures that couldnt be differentiated with the previous ICD-9 code set. What used to be one code in ICD-9 may be multiple or even many codes in ICD-10 that provide greater clinical specificity and can better indicate levels of complexity. For example, the codes differentiate body parts, surgical approaches and devices used. There should be fewer requests for more procedure information to validate reimbursement because of the greater specificity of the code set. However, knowledge and application of the correct code becomes even more critical. Protecting reimbursement will require extensive training not only of coders, but also of physicians and other code users, who must provide the
detail in clinical documentation that will identify and support the diagnosis or procedure. The specificity and expanded data will enable improved analysis of care delivery for quality and regulatory reporting. Increased detail for analysis also can be leveraged for process improvement and pay for performance. The Centers for Medicare & Medicaid Services (CMS) reports that coding professionals are advising organizations to begin training six months prior to the compliance date. The American Health Information Management Association (AHIMA) suggests starting three to six months prior to the date.
and quality reporting. Payor processes will be affected extensively, including medical policy, contracts and claims adjudication. All stakeholders must prepare to transmit transactions using the new 5010 format. The health IT systems that support the care stakeholders and processes will be affected wherever there is a diagnosis or procedure code entered, processed or transacted (visible or invisible), changes must be made. Because of the magnitude of the difference in the number of codes in the sets, many times there will be no crosswalks with a one-to-one match. Software mapping tools will provide an equivalency of one-toone, one-to-many, many-to-one, etc. The government is providing General Equivalency Mappings to help in the development of these tools.
healthcare data. CMS is requiring an update of the 4010/4010A transactions to the new ANSI X.12 Version 5010, which among other things will support the ICD-10 codes. ANSI 5010 must be in use by Jan. 1, 2012. See the 10 Steps for Providers to Get Ready for ICD-10 below for a high level checklist to assess your readiness.
4. Create a project plan detailing essential components for success: Key components would include communications, training and a software roadmap. 5. Identify clinical documentation required for coding: Reinforce the requirements in your organizations policies and procedures. 6. Schedule and implement updated IT solutions: Ensure your implementation schedule provides time to perform any system upgrades, test releases and install updates. Determine when and how long you need dual coding systems. 7. Train coders on new code sets: Review coder experience the new code set will require increased familiarity with medical procedures, anatomy and pharmacology. 8. Train physicians on new documentation requirements: Educate physicians on areas that require increased clinical documentation. 9. Perform service line assessments and potential impact to cash flow: Review coding that supports your key service lines and most commonly assigned and highly reimbursed DRGs. 10. Use enterprise intelligence analytical tools and reporting to monitor compliance and financial performance: Check first-time submission claims success rate, reimbursement turnaround time, days in AR, source of claim edits, source of denials and staff compliance/productivity.
Start Now. While the date to comply may seem far in the future, dont underestimate the amount and complexity of change that will be required. While many organizations are hoping for a reprieve from the Oct. 1, 2013 compliance date, CMS is holding firm at this time, saying there will be no delay. If you need assistance in getting ready for ICD-10, McKesson Practice Consulting Solutions offers services such as readiness assessment, roadmap development and implementation. For more information, please email consultinginfo@mckesson.com or call 1-800-789-6409.
Responsible for McKessons consulting services related to physician practice coding and compliance, Bredemeyer has more than 27 years of experience in assisting physicians, office, and billing staff with their coding and compliance needs. Prior to joining McKesson, Bredemeyer was the compliance and privacy officer for a large academic health center and was an active practicing critical care nurse. She guest lectures at physician forums and residency programs, and has authored several articles relating to physician coding and compliance.