Inpatient Facility Coding & Compliance Alert

Tip: Lessons from global neighbors could help smooth your transition.

With a five-fold increase in diagnosis codes and twenty-fold increase in procedure codes with ICD-10-PCS, your facility’s productivity is bound to take a plunge, with some experts predicting a 50-70 percent drop in coder productivity at least initially. Avoid going off the cliff with the following advice from those who’re already using I-10. 

Learn Global Lessons 

ICD-10 has been already implemented in  many countries. The UK switched in 1995, France in 1996, Australia in 1998 and Canada in 2004. We could use the experiences of these countries to make our transition smoother. 

Example 1: Canada followed a staggered transition to its ICD-10 modification known as ICD-10 CA from 2001-2005. The country decided in 1995 to adopt ICD-10, but took time to plan until 1999. They had less time overall to review and train because of their 2001 implementation date. According to information from groups such as the Northwest Regional Primary Care Association (RPCA), Canadian coder productivity is reported to have dropped by 50 percent immediately following implementation, and it took three long years to return to its pre ICD -10 levels. 

Example 2: By contrast, Australia started its training in 1995, provided facilities with an implementation kit in 1997, and conducted post-training surveys to gain feedback. They adopted ICD-10-AM (Australian Modification) in 1998, after beginning initial planning in 1994. Information from RPCA states that coders in Australia took only three months to rebound to pre-ICD-10 production levels. 

The rough transition to ICD -10-CA in Canada could be attributed to many reasons. Gillian Price, currently Project Director Canada at Quadra Med, was a consultant doing operational reviews for Canadian healthcare organizations during the transition to ICD-10. Despite all the teething problems, what ultimately mattered was that “patient care did improve with the detailed information offered by ICD codes,” Price said in an interview with the ICD-10 Watch website. 

Canadian healthcare providers were able to analyze the problems and bring the facilities on track, according to www.icd10watch.com. Lessons they learned that others can benefit from include: 

• Coders take onus: Medical coders needed to dive in and take responsibility to use informal learning resources on their own time and thus be a valuable and stronger asset in face of transition induced stress and probable increase in sick time and retirements.
• Get physicians on board: The physicians needed to get involved so as to understand the tools and systems that work for them, and champion the change in their facility thereafter.
• Learn better documentation: Every bit of documentation training would enhance the accuracy of the overall coding and the billing process. Medical schools could dedicate more hours to this in the curriculum itself so that a seamless system could be created.
• Not just a software update: Some  hospitals got their IT departments to create tools to accept ICD -10 and thought their responsibility ended there, Price explains in an article on the website Healthcare IT News (www.healthcareitnews.com). With time, they learned the importance of physician involvement and the roles of better documentation and coder training.
• Institutional resistance: With cynicism and inertia lurking at some places, it was hard to embrace change and work for a smooth transition.
• Cost overruns: Both budgets and timelines were grossly underestimated due to unavoidable delays and unknown variables that were not planned or anticipated. Price suggests adding 25 percent more to your budget. Although these countries’ healthcare initiatives are funded by government sources, while the U.S. transition is expected to be borne by providers and hospitals. Cost estimates vary widely and depend upon IT system needs. For a medium-sized physician practice (six to ten), estimates hover around $85,000 (from HayGroup, AAPC, CMS) vs. the $28,000 per physician cost the AMA is predicting.

Analyze Your Inefficiencies 

It is said that a chain is only as strong as its weakest link. With reference to the factors above, the additional year before ICD-10 implementation is the perfect time for facilities to analyze inefficiencies that thwart current performance levels – and strengthen your billing and reimbursement process chain. Ask questions such as: 

• What are the top reasons you receive denials? 
• Does the hospital have a strategy to reduce denials?
• How are medical necessity issues addressed?
• How frequently must physicians be queried for additional information?
• Is documentation provided in a timely fashion?

Remember: Even the smallest inefficiencies can multiply if not corrected, having an exponential effect on productivity slowdown.

Focus on Your Top Codes

The sheer numbers of codes in ICD-10 and ICD-10-PCS can be enough to worry any coder or administrator. Use the remaining months before implementation to cull through codes and determine which you’ll use most often. 

Here’s why: Some experts estimate that only about 3,000 codes control 80 percent of the revenue in a hospital. “Of course this estimate depends on the type of hospital involved, that is, small community hospital on up to a medical teaching center,” says Duane Abbey, Ph.D., from Abbey & Abbey, Consultants, Inc., in Ames, IA. 

Next steps: “Hospitals should closely examine their high volume services relative to changes in procedure coding,” Abbey adds. “Computer reports can identify high volume areas and then the coding changes can be assessed along with possible increased documentation requirements. By focusing on high volume, and generally high dollar, areas both coding and the supporting documentation can be addressed in a focused manner through increased training.”

Reality check: Facilities will need to prioritize by determining the most common codes. The coding teams will have to divide themselves so as to focus practice time on specific diagnosis or procedures important to the facility. 

Don’t Overlook the Affordable Care Act Effect

With the dawn of Affordable Care Act, about 40 million new patients are expected to enter health care. This will create an enormous demand for new coding professionals in the time to come.

Resource: To read more go to http://thehill.com/blogs/congress-blog/healthcare/190168-obamacare-will-create-healthcare-jobs.