Submitted by Antonio Arias, MBA, CHBME on Tue, 10/25/2016 - 8:00

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5 Tips for Thriving in an ICD-10-Only Landscape

With October 1, 2016 now behind us, we’re living in a new “ICD-10-only” era. Even though the updated diagnostic code set became the norm in fall 2015, the CMS’ one-year grace period (in which providers could still utilize unspecified codes for Medicare fee-for-service claims) has come to a close.

While the flexibility in coding has been a welcome leniency for many medical practices, it has also allowed providers to be less diligent about meeting the updated code standard than they should be. In the new ICD-10-only era, failure to code claims properly will create real consequences – ranging from resubmissions to denials to delays.

If your practice has leaned too heavily on the grace period, now is (past) the time to get serious about ICD-10. Here are our the top tips our medical billing services has about complying with the CMS’ requirements.

Enhance Staff Education: Hopefully, you already invested in comprehensive training to educate your team on ICD-10. Regardless, you’re wise to recirculate your training materials around the office and remind all administrative and clinical staff members that it’s everyone’s job to keep an eye out for errors – not just the medical billing team’s.

Stay as Specific as Possible: The biggest change of the shift to ICD-10 (especially after the grace period) is the increased onus on providers to code claims to a much higher degree of specificity. Since most private payers haven’t been as lenient as the CMS on this front – many have already been requiring resubmissions or issuing denials for inspecificity – remind your team that all claims deserve the same diligence from here on out.

Monitor for Troubling Trends: Keep a closer eye than ever on your practice’s denial rates and unpaid charges in accounts receivable. If there’s a spike in irregularities in a certain area of your medical billing operation, it may be a bad sign that your ICD-10 efforts aren’t up to snuff.

Check Your Tech Toolset: Are the code choices in your practice’s electronic health record (EHR) and medical billing system entirely inclusive of ICD-10 options? If your solutions rely on an incorrect or incomplete code file, you won’t be able to get your claims through clearinghouse edits. Investigate your compatibility with ICD-10 from a technology-first perspective (consider engaging an expert consultant, if necessary).

Ensure Your Resources Are Up-to-Date: Your most commonly used documentation tools – encounter forms, diagnosis checklists, reference files, and more – are your first line of defense against ICD-10 errors. Since 2016 is soon coming to a close, update all of your resources with the new 2017 ICD-10-CM codes.

For more help ensuring ICD-10 accuracy, contact a trusted medical billing company.

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Topics: Practice Management, Medical Billing Company, Meaningful Use Stage 2

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