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Claims and Coding: Roundup


As the healthcare industry undergoes conversion from about 17,000 ICD-9 codes to more than 155,000 ICD-10 codes on Oct. 1, 2013, we asked our panel of experts the following question:

As we continue transitioning to ICD-10, what are the best ways to reduce claims and coding errors?

Increased specifi city makes accurate documentation critical

Garri Garrison, director c ,

consulting services, 3M Health

Information Systems

ICD-10 brings a dramatic increase in the number of codes, from about 17,000 today to more than 140,000, which allows for a much greater level of specifi city in coded patient data. This increased code specifi city makes accurate clinical documentation critical to achieving accurate coding and billing. Physicians are already challenged to meet documentation requirements under ICD-9, so focusing on clinical documentation improvement (CDI) early in the ICD- 10 transition process is important


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for success. Not only is it essential because of the time needed to educate physicians in ICD-10’s complexity, but also because of the potential impact on revenue from incomplete or inaccurate documentation. Establishing a CDI program with concurrent documentation review helps verify that a patient’s complete clinical status is accurately captured in the medical record, which leads to more precise coding and billing. Software tools and services are available to help educate physicians, and to assist coders and documentation specialists in querying physicians for more information. Implementing these tools now helps physicians understand how to document for ICD-10 well in advance of the 2013 deadline. To help coders become effi cient in ICD-10 coding, many hospitals are relying on computer-assisted coding (CAC) technology. CAC can speed documentation review and help coders quickly identify missing or incomplete information in the patient record. Implementing CAC now can help offset productivity losses with ICD-10.

8 July 2011

ICD-10 could turn revenue cycle management upside down

The best ways to protect the

revenue cycle and ensure proper payments start in patient access. Correct coding, medical necessity and all the other aspects of capturing information on the front end will be profoundly expanded once the industry transitions to ICD-10. Collection of co-pays, deductibles and patient payments will be greatly complicated; therefore, providers will need to ensure their systems have the capacity to analyze expected procedures to the payer contracts in order that informed decisions can be made prior to the rendering of care.

Doug Bilbrey, The SSI Group

Secondly, claims-processing systems will be of vital importance to ensure proper ICD-10 codes have been captured and to ensure all applicable codes are included in the electronic claims transactions. Further, these systems should have the capacity to calculate expected reimbursement to empower the providers with the tools to accurately forecast revenue. In addition, systems should include functionality to track utilization of the ICD-10 codes to ensure proper documentation is available to substantiate billed procedures. Lastly, the electronic remittance and contract management systems will play a vital role in determining whether proper payments to the providers have been made.

So to sum up, patient access benefi t verifi cation and utilization systems, documentation, contract management, claims management, remittance processing and analytical systems are the keys to protecting the revenue cycle.



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