ICD-10: What’s next?
ICD-10 implementation day came and went without much ado; however, this is just the beginning. Even the best laid plans will have some gaps to fill in as we start to follow the first claims through the entire revenue cycle.
Here are a few thoughts on monitoring the process to avoid gaps in your revenue stream.
Check with vendors
Check with your vendors to see if ICD-10 LCD and NCD policies are loaded. If not, you can manually pull the policies here and use them to correct medical necessity denials. Learn more here.
Update guidelines with your billing or charge review staff. Any diagnosis specific rules should be reviewed and updated. For example, encounters with vaccines should be submitted with Z23 going forward.
Review denial trends
Look at your denial trends pre and post ICD-10. Medical necessity (CO 50 ANSI code) and payor specific trends will likely be the most telling. We have heard the payors are ready, but due diligence is required to verify positive outcomes.
Hone documentation skills
You have 12 months to hone documentation skills to support the correct level of specificity. Start now with one or two disease groups and work your way through all applicable categories for your practice.
From CMS: “While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, if a valid ICD-10 code from the right family (see question 5) is submitted, Medicare fee-for-service will process and not audit valid ICD-10 codes unless such codes fall into the circumstances described in more detail in Questions 6 & 7.” See the full Q&A here.