ICD-10 Transition: Monitor to Catch Problems Early

Healthcare providers sailed through the first month of transitioning to the new ICD-10 coding system, according to CMS. The government agency said the number of claims submitted held steady and there were no significant increases in rejections. However, experts caution that providers should watch their reimbursements closely for any unexpected drops in revenue in the coming months.

“The most important thing is for organizations of all sizes to monitor their internal activity so they know immediately if the transition has had any negative impact on their revenue stream,” says Pamela Jodock, senior director, health systems solutions, for the Health Information and Management Systems Society. “You need to have  processes in place for monitoring and responding to spikes in activity.”

Part of that vigilance is keeping on top of denied claims, says Deborah Grider, CPC, past president of the Indiana Health Information Management Association and a frequent speaker and consultant on ICD-10 implementation.

“You need to work those denials quickly and sort them by type,” she says.

“If you notice that you are getting more denials for invalid or unspecified coding or not meeting medical necessity, you need to sort and track them to get an idea of who is denying what.”

Practices who took advantage of the time leading up to the Oct. 1 transition should already have a handle on their denial rate under ICD-9 as a baseline for comparison, experts say. Here are some things you should do going forward to catch and fix any glitches in your processes or workflow before they affect your bottom line:

Review your top 10 codes. In addition to monitoring overall denials, you should regularly run reports on the codes that you bill most frequently because those denials will have the biggest impact on your revenue. Similarly, run separate reports on your highest-volume payers to look for trends in denials.

Keep on top of accounts receivable. Review A/R weekly rather than monthly. Although many practices prioritize getting claims out the door before looking at pending or denied claims, it is essential to address denials as soon as they come in to avoid repeating potentially costly errors.

Don’t rely on the grace period. Medicare has announced it won’t reject claims solely due to unspecified coding during the first year of the transition, giving providers a chance to make adjustments. Don’t wait for that enforcement to kick in to get your documentation up to speed. You should start with a solid foundation and take advantage of the grace period to work out minor glitches.

Create a cheat sheet. Create a list of the most common diagnoses used in your practice and their corresponding ICD-10 codes. It takes some research upfront but may save time later searching for codes, which can cut into productivity.

Schedule audits. Give yourself to the end of the year to get up and running, then start auditing your coding on a regular basis. Schedule audits once every three months to assess the accuracy and specificity of your coding and documentation.