We have now entered into the defining moments of the upcoming ICD-10 Implementation. It’s time to separate the “men from the boys” and the “women from the girls.” It is a time of uncertain change and for those physician practices and hospitals that may have procrastinated, a harsh wake up call. The federal government did not spend millions of dollars preparing their operations and IT systems with no thought to a return on investment. The bottom line? The government will recoup their investment through auditing physicians’ medical records. Paid on commission, the auditor is compensated by finding errors and omissions in physician documentation.
How can you ensure that your clinical documentation will not be contributing to the auditor’s bonus? The best advice I could give would be to stay off their radar by submitting clinical data on claims according to Federal guidelines and regulations. Physician practices and hospitals need staff who are not only skilled, but who genuinely have their organizations’ best interests in mind. Many health systems have come to realize the importance of continued training and education for its employees and providers. With October 1 only weeks away, flying blind and attempting to figure things out as you go is not an option. The consequences for ICD-10 noncompliance are harsh and compromise the reputation of providers and hospitals. Further, it can be humiliating and damaging in several other ways given that audit findings are public knowledge.
Organizations and practices should be positioning themselves for success over the next 10 weeks. Here are some of the tasks that need to take place right away:
- Complete training for the providers and other clinical staff on ICD-10 documentation requirements and opportunities by working with them directly in the EHR they will use on a daily basis to capture the clinical information. PowerPoints may be helpful as an adjunct tool but, in my experience, the electronic medical record should be pulled up and providers need to walk through actual patients visits of their own or of the organizations case mix step by step, from the inception of the visit to the dropping of the charge. This is the surest way to develop best practices on how to actually capture the specificity in the documentation and in the coding for billing purposes.
- Make sure there is a denials management process in place and back up staffing to mitigate productivity losses. Co-pays will need to be collected by diligent front desk staff. Obtaining correct, thorough information on eligibility and pre authorizations are critical. Any patient information going into the EMR or EHR demands intentional efforts to focus on accuracy.
- Remember that “you don’t know, what you don’t know” and as AHIMA tagged in their magazine adds, “What you don’t know can hurt you.” Leverage staff who are highly skilled in many areas (hard skills and soft skills) and who are consistently watching the industry and providing guidance and direction based on what they are seeing. A “feedback loop” needs to be established for the organizations and practices to stand a chance in the fast changing industry of healthcare.
- Embrace the importance of a culture of collaboration across all areas: Clinical, operational and technical.
- Determine your contingency plans throughout the revenue cycle operations and around the technology issues that may arise.
- Communicate, communicate, communicate.