Building ICD-10 Compliance in Physician Practices

by | Published on Feb 18, 2014 | Medical Coding

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The U.S. Department of Health and Human Services (HHS) has set October 1, 2014 as the deadline for all HIPAA-covered healthcare providers to convert to ICD-10 codes. Compared to 13,000 diagnostic codes in ICD-9-CM, the ICD-10-CM revision has more than 68,000. Moreover, ICD-10-CM introduces alphanumeric category classifications for the first time and has many more categories than ICD-9-CM. With less than a year to go, most physician practices are apprehensive about the changes that transition to ICD-10 will bring about such as the need for more specificity in documentation and medical coding and billing variations.

So it’s important to make sure that your practice is well prepared for the ICD-10 transition by adding ICD-10 to your compliance plans for 2014 and beyond. Your compliance plan should include ICD-10 risk assessments, auditing and monitoring, training, communication and incident management, advises an industry expert in an article published on the AAPC site.

  • Risk Assessments – Perform an initial practice workflow or ICD 10 impact assessment to get a thorough knowledge about the crucial vulnerabilities to your practice and find out how they will affect work flow and revenue. This will help to avoid potential frauds and other allegations and minimize their effects. It is very important consider all the areas that the transition would affect such as management, documentation, clinical areas, lab orders, system, front-office jobs, coding and billing.
  • Conduct Audits – By conducting a baseline audit on your documentation, you can determine the level of training that will be needed for ICD-10 compliance. It has been estimated that, on average, ten records per provider are all that is needed for such an audit. This can help address revenue integrity and false claim issues. Incorrect coding issues can be identified by auditing claim submissions before and after payments. Educate your staff about the importance of clinical record documentation and the need for record compliance with ICD-10.
  • Training – Physicians should enroll in training sessions on new documentation requirements. In-house coders and billers, they would need to be trained on the new code sets. Practice staff should be made aware of their new responsibilities when ICD-10 is implemented.
  • Encourage Communication – Practice management and staff should share their opinions and be well-informed about the necessary changes. This can help mitigate potential issues. If concerns are reported immediately, corrective action can be taken quickly. Routine staffs meetings help keep the lines of communication open.
  • Incident Management – If a potential non-compliance issue is found or reported, document the incident and further investigations. This will help to take corrective measures quickly.

Outsourcing your billing tasks to a professional medical billing company can help to avoid non-compliance issues related to ICD-10. Professional service providers have a team of trained, AAPC-certified coders and billers who are ICD-10 ready.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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