Looking ahead: coding concerns in 2017

November 30th, 2016

Now that we have officially entered the holiday season, it’s natural to start thinking ahead to the New Year and what 2017 will bring. Even though on the calendar the ICD-10 transition is long gone, it’s to be expected that medical organizations and practices will still likely feel the effects of the changes into 2017 and perhaps beyond.

According to a recent article published by Modern Medicine Network, practices should start being proactive with these coding opportunities now to consider how the following five factors will impact documenting, coding and billing for care. Here are their top 5 tips for combatting 2017 coding concerns:

Team effort

In everything from data capture to patient care, all responsibilities can no longer fall solely on physicians’ shoulders. Implementing workflows that allow clinical support staff to understand and share documentation duties, for example, can alleviate some of the burden from physicians.

MACRA

It’s critical that practices understand the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)—and more specifically, the Merit-Based Incentive Payment System (MIPS). A 2016 survey showed that 50% of physicians say they have never heard of MACRA. This makes it vital for all practices, even those with few Medicare patients, to pay attention to the impact this bellwether legislation has on documentation, coding and reimbursement.

Practices should task their revenue cycle staff with understanding MACRA/MIPS and setting practice policy. The MACRA/MIPS leader can gather instructional information about the program from physician-specialty trade organizations to educate the practice and implement processes to help fulfill its requirements.

Staff training

As we’ve been stressing since long before the ICD-10 transition, training is crucial. Elevating staff expertise to a higher level of coding and billing knowledge is necessary, but doesn’t need to be tackled alone. Engaging an experienced and knowledgeable partner to assess documentation and coding practices can also help optimize revenue cycle processes.

Denials

If physicians are seeing denial rates grow from their pre-ICD-10 baselines they should conduct a careful assessment of how their care teams are capturing data and how coders and billers are accessing that data and billing for services. Although denial rates may have stabilized since the ICD-10 transition, do not be surprised if they escalate again as payers now have close to a year of ICD-10 data and begin to develop more aggressive medical necessity models.

Documentation and coding accuracy

While accuracy has always been essential, its importance is unparalleled now due to two dynamics: the increased specificity of ICD-10, and the quality improvement requirements of value-based care models. The need for more detailed information is adding to daily workloads – it’s estimated that 1 to 2 hours of per day in fact! Rather than trying to save time (and creating a billing compliance risk) by using a cut-and-paste documentation approach, a better strategy is to enable physicians to quickly capture discrete data in the electronic health record using the software’s advanced documentation functionality while offering the flexibility to add unstructured notes when necessary.

Being proactive about these issues should be on your New Year’s resolution list! Let Elsevier help improve the fiscal health of your organization – contact us today to find out how!