Truth #1 Increased Denials
AMA has predicted denial rates as high as 20%. This is precisely why they took steps to push a mandatory “grace period” for ICD 10. http://www.audiology.org/practice_management/coding/cms-creates-one-year-grace-period-transition-icd-10
There is no reason to panic over denial rates before they happen. The key here will be to implement a better denial management effort. Medical practices should be sure they understand what triggers denials now and compare those stats to the effect ICD 10 would have on their existing denial rates. Take the time to analyze the before and after picture. This will better prepare you for the management decisions you will be faced with during this trial period. Act now!
Truth #2 The Number of Queries will increase
The truth of this section is that if your physicians are not in the habit of documenting at the required level of ICD 10, your queries will increase. That’s the bottom line. These habits affect both coders and clinicians. Prepare your practice now!
Keep your documentation process running smoothly by assuring your medical coders are improving their queries making them as useful and efficient as possible. Write in clear, concise language. Avoid leading questions and use evidence specific to the case. Start using ICD 10 language now.
Truth #3 Loss of Productivity
ICD 10 has been presented to the medical community in such a way it has practices in a state of fear. It is so large and so complex that coders aren’t going to be able to keep up with their current workload. Canada’s coding productivity dropped 40% after their ICD-10-A implementation, however, they also switched from paper=based claims to PC-based systems simultaneously. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3432251/
We don’t know for sure if American coders will face the same debacle but we know for sure we can be ready for these challenges by increased education and training coupled with strong clinical documentation improvement.
The Biggest Truth
The efficiency of America’s medical practices billing operations has a critical impact on financial performance. One of the most important decisions you will make this year is whether an in-house team or a third party company will answer the call when it comes to ICD 10’s success or failure in your practice. www.emeraldar.com
Billing and collections companies have been preparing for an increase in post-insurance patient balances. The issue is “Has your practice billed the patient’s claim correctly?” Along with America’s ambition comes America’s opportunist mindset. Will you hold bad debt longer because of your insecurity that your team has billed correctly? Will you risk an angry patient base over incorrect patient balances being billed to the patient or worse yet turned to a collection agency? Beware the line of attorney’s waiting for those mistakes to occur.
Be prepared now. ICD 10 is coming and is here to stay. Wishing will not make it go away. Take the steps now to assure you are ready but don’t be afraid. Change is the only constant we know.