July 25, 2016

Reducing Your Risk and Staying the Course

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One thing always remains the same in healthcare: change. With the implementation of ICD-10 we found out how disruptive some of these changes can actually be, and it appears that this was only a precursor to even more change in healthcare, with the implementation of new quality payment initiatives.

During the ICD-10 implementation, we began to work with physicians on their clinical documentation to prepare for the demands for greater specificity. We now can approach these new quality-based initiatives not only from the perspective of clinical documentation improvement (CDI), but also with lessons learned during the implementation period. 

We know how important clinical documentation is to the health of any practice, and we need to make sure we continue those efforts no matter what the timelines are for implementation of future payment methods. Here are a few areas where we can continue working on improvements, following some of the same framework we used for ICD-10.

Remember, no deadlines have been set yet, only proposed. That doesn’t mean we stick our heads in the sand until we are forced to act, however; that approach did not work well for ICD-10 implementation.

  1. Educate clinicians and staff on potential changes and proposed regulations to build awareness.
  2. Evaluate patients for chronic conditions, and also work on patient engagement, recalls, education, and follow-through. Make sure you have game plans in place.
  3. Evaluate staff skill levels; make sure everyone that documents in the medical record understands the importance of the end result.
  4. Throw out your “cheat sheets,” and be sure to capture all the clinically relevant information in the coding process. Be sure to include comorbid conditions as applicable.
  5. Review your claims data; make sure you have clean information going on your claim forms. 
Claims data should match your medical record – many times, what is found on the claim form is not what the documentation states in the medical record. Also, audit your processes; it is imperative that these match and that all information is captured. 

A few more tips: 

  1. Work with your vendors. Make sure you are aware of all the solutions they offer and how they may benefit your practice and your patients.
  2. Meet regularly. Discuss improvements, progress, and shortfalls. Continued communication will strengthen improvements.
  3. Evaluate: figure out what is working and what processes still need refinement. Utilize PDSA (plan, do, study, act)
  4. Budget; with new quality initiatives, it may be necessary to change your practice to meet new needs. As such, set some money aside now so that you are ready (if it turns out you don’t need it, then at least you will have reserves available).
  5. Don’t procrastinate. Change is inevitable. Make what improvements you can now, despite not knowing deadlines for implementation. Your practice will benefit from any improvements you make.
There are still a lot of unknowns for the implementation of these new quality initiatives, but we can mitigate our risks by working through improvement processes now. If it does turn out that 2017 data is going to shape our future payments, we will want to make sure we are ready, because having to wait another two years to achieve positive results could be damaging to most practices.

Clean claims data will help us, so be sure to review your processes.
Rhonda Buckholtz, CPC, CPMA, CPC-I, CRC, CDEO, CHPSE, COPC, CPEDC, CGSC

Rhonda Buckholtz has more than 25 years of experience in healthcare, working in the management, reimbursement, billing, and coding sectors, in addition to being an instructor. She was responsible for all ICD-10 training and curriculum at AAPC. She has authored numerous articles for healthcare publications and has spoken at numerous national conferences for AAPC, AMA, HIMSS, AAO-HNS, AGA and ASOA. She is a past co-chair for the WEDI ICD-10 Implementation Workgroup, and current co-chair of the Advanced Payment Models Workgroup and has provided testimony ongoing for ICD-10 and standardization of data for NCVHS. Rhonda is on the board of ICD Monitor and the AAPC National Advisory Board. Rhonda spends her time as chief compliance officer and on practice optimization providing transformational services and revenue integrity for Ophthalmology practices. She was instrumental in developing the Certified Ophthalmology Professional Coder (COPC) exam and curriculum for the AAPC.

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