ICD-10: One Year Later

ICD-10: One Year Later

So, here we are. October has come and gone … which means the grace period for ICD-10 has officially ended.

And that means several things for your practice.

ICD-10 was implemented in October 2015. The Centers for Medicare and Medicaid Services issued a year-long grace period, which meant that as long as claims were submitted within the proper code family, they would be accepted.

But that grace period officially ended on October 1, 2016.

So while everyone was pleasantly surprised with how smoothly the initial ICD-10 rollout went, this could mean an uptick in denials.

Debi Primeau, the president of a health information advisory firm, said in an article published in Becker’s Hospital CFO (http://www.beckershospitalreview.com/finance/a-year-of-icd-10-healthcare-professionals-weigh-in.html), that she predicts that healthcare organizations that have still not conducted any sort of audit on coding and documentation may have some “surprises” now that the grace period has ended.

“Hospital leaders can’t afford to let sloppy coding practices slide, especially as Medicare will not accept unspecified codes [anymore],” she said.

“ICD-10 is still new to some coders who haven’t implemented best practices,” said healthcare consultant Mary Beth Haugen in the same article. “If an organization has not been diligent in auditing coders and providing feedback, it may be at risk for an increase in denials.”

Carol Paret, the person responsible for the ICD-10 transition at a large healthcare provider in Texas, told HealthcareITNews.com that she’s a little concerned that the grace period may have just delayed some of the impacts we were originally expecting last year.

“We did lower our coding productivity standards by 20 percent and are still down,” she said (http://www.healthcareitnews.com/news/hospitals-gird-icd-10-claims-specificity-cms-grace-period-ends). “We’re still struggling a bit with documentation at the specificity we need. … Denials as a whole are a challenge. We’re expecting more when the grace period is done.”

So, what can you do now to help avoid additional claim denials?

Ann Bina, the vice president of compliance fulfillment at a healthcare consulting company, recommends several things in an article in Physicians Practice (http://www.physicianspractice.com/icd-10/9-tips-surviving-after-icd-10-grace-period-ends):

Be specific: “Keep in mind that documentation is used or more than billing,” she writes. “From a continuity of care and a risk management standpoint, documenting to the highest specificity is in the best interest of all providers.”

Watch denials: “Practices should continue to monitor both denials and account receivable unpaid charges to ensure there are no issues with claims an receiving payment,” she writes. “A denial trend is often the first sign that something is wrong with your claims.”

Review systems: “It’s good practice to review the code choices in your EHR and/or billing system to ensure the most specific codes are available as code choices,” she writes.

If you have the bandwidth, it’s also a good recommendation to have all of your claims double-checked before submitting to ensure accuracy. A second set of eyes never hurts.

By doing these things, you can help reduce the impact of the end of the grace period.

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