October 25, 2011

Coders are Key to Revenue: Make Sure They’re Prepared for ICD-10

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EDITOR’S NOTE: The following article — part one of a two part series — is based on one of three presentations at the HIMSS Oct 12, 2011 briefing. The second part of this series summarizes key points of the big picture presented at the October HIMSS Virtual Briefing. Watch for "Focus on Finances: How will ICD-10 Effect Your Bottom Line?"

Will the coders in your organization be ready for the new ICD-10 system by the October 1, 2013, implementation date? In fact, will you have the number of experienced coders you need to do the job when that date rolls around?

 

In the latest HIMSS virtual briefing (held October 12), the following two speakers addressed the above in their presentation entitled “Prepare Your Staff: Planning for the ICD‐10 Implementation Medical Coder Shortage.”

  • Kenn Beckwith, Director, Experis Healthcare (ManpowerGroup); and
  • Kim Reid, CPC, CPMA, CEMC, CPC‐I, Director, ICD‐10, Development and Training, American Academy of Professional Coders (AAPC).

The abstract to their presentation sets the stage by saying, “The implementation of the ICD-10 conversion in your organization is going to affect the daily activities of many of your organization’s employees. No groups of employees are going to be affected more than your medical coders. The potential for risk with the conversion is only increased by the continuing industry-wide shortage of certified medical coders….”

In a direct message to healthcare leaders, Beckwith stated that a “significant portion of your reimbursement depends on your coding team,” and that “coders are critical in the delivery of compliance and revenue.” Unfortunately, the transition to ICD-10, which may last between six and 12 months, will interfere with “business as usual” since those very valuable staff members will be learning to use a totally new coding system.

Due to this fact, Beckwith and Reid alerted physician offices and institutions to expect the following:

  • Delays in reimbursements, increased denials and increased rejections;
  • Decreases in coder and clinician productivity that could affect revenue (AAPC estimates a productivity decrease between 10 and 25 percent.);
  • Operational disruption due to the need for testing; and
  • Increased queries from coders regarding code selection and increased billing inquires from health plans.

Although coders are the key players, other staff also contribute to the process, including physicians and nonphysician practitioners, nurses, practice managers, and front-desk staff. It may seem like “everyone plays a role in the coding process,” says Reid, and they should be equipped to do it successfully.

Plan for Education

Between three and 10 coders are over the age of 50, and many of them are considering either early retirement or changing professions to avoid ICD-10. Therefore, each organization will need to determine whether it will lose a portion of its current coding team. It’s likely that some providers will need to hire new certified coders or newly trained and certified coders.

Once the coding team is in place, be sure to inform them about your facility’s plan for the ICD-10 implementation and incorporate them into the transition team. Managers who work with them in this way can better evaluate their overall confidence and competencies, and use these observations to develop training, which should average around 70 to 80 hours, according to the AAPC.


 

 

Even though ICD-10 training for coders should not begin until late 2012 or early 2013, an educational plan should be developed earlier. Internal educators should learn code sets first, so they can begin working with providers.

Education for the new system involves more than just learning how to assign the new codes, and Reid suggests the following be incorporated into the plan.

  • Either an in-depth or refresher course on anatomy and physiology and how it relates to ICD‐10;
  • A general overview of the contents of the final rule related to implementation of the new system;
  • A more in-depth presentation of the ICD-10-CM and ICD-10-PCS systems, focusing on their organizational structures and how they differ from the ICD-9 systems;
  • Review of the ICD-10-CM Official Guidelines for Coding and Reporting 2011 published by the National Center for Health Statistics (NCHS);
  • How to use GEMs (general equivalence mappings)—two-way translation tables for diagnosis and procedure codes published by CMS to convert data from ICD-9-CM to ICD-10-CMS and PCS and map from ICD-10-CM/PCS to ICD-9-CM.

Clinical Staff

To ensure the “loop is seamless,” clinicians must also receive training, particularly since “many physicians don’t recognize how their documentation will affect codes,” says Reid. They also don’t realize the importance of coding, so specialized and directed training (whether on-site or via e-learning) for physicians and nurses should be held with a focus on their specialties.

As Reid says, “Let’s face it, physicians did not go to school to learn how to code” and, in fact, it’s not even taught in most medical schools. “Allow them to do what they do best – treat patients,” but get them on board to provide better, more comprehensive reimbursement by explaining how the system works and how their documentation affects payment. Understand that “better documentation does not necessarily mean additional reimbursement will be received, but it does mean that you will get to keep it once you receive it!”

After the Launch

 

Even after the ICD-10 system goes “live,” some health plans may not be ready to accept ICD‐10‐CM codes. Physicians’ offices and institutions must designate someone in the organization to “troubleshoot” problems, whether they be with the system, coding, documentation, or other implementation compliance problems).

Although there are numerous challenges ahead for the healthcare industry beyond the above, Reid believes that proper planning and education will clear the road significantly. Instead of fearing the future, everyone should “embrace the changes,” she says.

 

 

Read 13 times Updated on March 16, 2016
Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.