October 13, 2014

ICD-10: Think “Improvement”

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If there’s anything that we can all get behind, it’s improvement. We’re constantly striving to improve our health, our homes, our brains, and our lives. There’s a whole industry of professionals dedicated to process improvement.

We’ve all had the experience of working for an organization that was either in desperate need of process improvement or in the midst of it. Hence, the term “change management” was born, because ultimately we all have issues with change that make process improvement somewhat difficult sometimes. But I digress. This is about improvement.

The Merriam-Webster Dictionary defines improvement as:

  1. The act or process of improving
  2. a. The state of being improved; especially: enhanced value or excellence
    b. An instance of such improvement: something that enhances value or excellence

Improvement is both a process and state of being, and one leads to the other. We know that this is the essence of ICD-10. Yet, even in our improvement-driven society, we often are slow to initiate changes that will ultimately enhance our business, health, and lives.

Change is hard. I know.

So I’d like to present some opportunities for process improvement that are simultaneously good for the physician’s office today as well as setting the stage for ICD-10 implementation. In other words, there is nothing to be lost by implementing these improvements, regardless of ICD-10.

Isolate your workflows that involve coding and documentation. You don’t need to hire a consultant to do this. You can work this into daily workflows by leveraging the staff’s knowledge about their tasks and responsibilities. Engage them in the idea of identifying areas that need improvement when it comes to documentation and coding. Whether it’s a manual or automated process, there is an opportunity to take a moment to identify what is being done today and how it can be improved. In terms of ICD-10, this will help narrow down the processes that will require changes, either from a manual input perspective or an automated perspective. The benefit of doing this work is that regardless of which code set is being used, more efficient and accurate processes will lead to more efficient and accurate reimbursement. We can control the cost of ICD-10 implementation by being mindful about the improvements we need to make in order to support accurate coding and documentation.

Review your aging reports. It is imperative to look behind you and clean up any looming reimbursement issues. When ICD-10 goes into effect, a layer of complexity will be added as we all begin to see the real-world outcomes of using the code set. It makes sense that anything that has been lingering will be a distraction to the issues that will come up as a result of the transition. But regardless of ICD-10, it is beneficial to the overall health of any physician practice to review accounts receivable balances on a regular basis and set realistic goals and expectations for outstanding claims and patient balances. Ensuring that there is an efficient turnaround when claims are denied is critical. Otherwise, any issues that arise with claims denials because of the transition will only exacerbate the problem.

Clinical documentation is essential. And despite the repetition of messaging in terms of improving clinical documentation in preparation for ICD-10, this cannot be overlooked as “ICD-10 hype.” There is ample evidence that current clinical documentation is far from perfect. Even if ICD-10 wasn’t happening, clinical documentation is still vitally important to healthcare. Without documentation, there is nothing on which to base a physician’s charges. Therefore, it would stand to reason that a physician would want to provide only the best possible clinical documentation in order to support their charges. Sometimes this means that physicians are missing out on reimbursement because they are not specific enough or aren’t documenting comorbid conditions. It also may be something as simple as legibility. If it can’t be read, it can’t be coded.

Claims submission is the key to the kingdom. Claims are only paid once they’ve been submitted, so the claims submission process and players should be scrutinized. Again, this doesn’t mean a team of experts needs to be hired to analyze your processes. This means that each person involved in the process should begin analyzing what they do and how it can be improved to save time and ultimately money. If this means reevaluating certain external partners such as clearinghouses or vendors, then now is the time to do that. Improvements can only happen if all parties are involved and working toward the same goal. Also, turnaround time for claims submission should be evaluated for any opportunities for improvements in efficiency and timeliness. Establishing a cushion for claims submission timelines to compensate for the ICD-10 learning curve may save your bottom line (or at least make productivity losses less painful).

Focus on what you know. There’s a lot that has been said about training. Training is important, but it doesn’t have to be all-encompassing and break the bank. Every physician’s office knows what its case mix is. Leverage that knowledge to identify where training is needed and narrow down the scope. Take advantage of the free training resources available through the Centers for Medicare & Medicaid Services (CMS) and identify any gaps that may require purchasing external training. Don’t worry about what you don’t need to know.

If ICD-10 can bring about momentum in the form of collective improvement, even on the smallest scale, then I consider that a success. Let’s continue to focus on the things that are important and require improvement.

Over time, the rest will follow. And regardless of ICD-10, we will be better off for it.

About the Author

Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial and public payers. She is also co-chair of the Workgroup for Electronic Data Interchange (WEDI) ICD-10 Coding and Translation Subworkgroup. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.

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Mandy Willis, CCS, CPEHR

Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial and public payers. She is also co-chair of the Workgroup for Electronic Data Interchange (WEDI) ICD-10 Coding and Translation Subworkgroup. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.

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