Policy & Regulation News

How to Manage ICD-10 Implementation Updates, Maximize Revenue

AHIMA has released a guide on how to prepare for upcoming ICD-10 implementation updates that could help organizations boost claims reimbursement.

By Jacqueline LaPointe

- Just as most healthcare stakeholders reported that ICD-10 implementation ran smoother than expected, CMS will be releasing 5,500 new codes beginning in October. While it may sound like a large update to the system, the new codes could help providers submit more specific claims and boost their reimbursements.

More training and audits to boost ICD-10 implementation and hospital revenue

To help organizations prepare for the updates, the American Health Information Management Association (AHIMA) has released a guide on how to implement upcoming ICD-10 updates.

As the CMS freeze on the addition of new codes thaws, AHIMA reassures providers that ICD-10 implementation for the updates could be easier than the initial transition.

For the most part, CMS will release codes that most providers were already seeking, such as healthcare specific devices. The update will also include combination diagnoses, like diabetes comorbidities and more specific cancer codes. Most of the new codes (3,651) are related to inpatient procedures and 97 percent are for cardiovascular procedures.

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  • AHIMA noted that the update “narrows the impact to specific service lines,” which could make staff training easier.

    Health information management professionals (HIM) should start by reviewing the new ICD-10 codes on the CMS website and assessing how the updates will affect hospital quality and reimbursement, explained the guide. Some updates may reiterate existing procedures while others could account for newer treatments.

    “Performing that assessment now will help HIM target its training and education activities to those that will be most impacted in light of one’s organization’s services and case mix,” stated AHIMA’s guide.

    As part of the organization’s assessment, HIM leaders should evaluate the accuracy of current ICD-10 coding procedures, which could impact claims reimbursement. AHIMA suggests that organizations review charts and denials as a result of incorrect coding.

    “Another step to consider is reviewing care manager notes to see how specific diagnoses or procedures are worded in order to identify potential misalignments with the coded records,” explained the guide. “The goal is to identify gaps and patterns that will enable HIM to focus training on key trouble areas.”

    Another key step to preparing for ICD-10 implementation is maximizing technology to ensure a smooth transition. AHIMA recommends that providers discuss encoder updates with their EHR vendor before the October 1 deadline.

    Many organizations may also benefit from employing computer-assisted physician documentation technology, which helps providers select the most specific code for the diagnosis and procedure.

    “Forward looking organizations are also leveraging analytics to help optimize their coding processes,” wrote AHIMA. “Analytics can be used to identify records for auditing, improving efficiency while effectively targeting areas in need of improvement. As the number of codes expands, increasing complexity, using automated intelligence to support human review will become more important.”

    In addition to technology, employees will be the driving force behind implementing ICD-10 updates, which means that organizations should focus on comprehensive training.

    “The arrival of new ICD-10 codes is a reminder that training is not a one-time event,” stated the guide. “Continuously evaluating coding procedures and providing education to improve accuracy and efficiency are vital. This means not only training for the new codes, but also reviewing existing ICD-10 codes that may be causing difficulties.”

    Through additional education, providers could learn how to maximize revenue by accurately coding cases. For example, a coder needs to understand the difference between a leadless and traditional wired pacemaker, especially since the leadless pacemaker qualifies for a higher reimbursement.

    By providing regular training, organizations can anticipate future updates to the system and ensure that claims are accurate.

    AHIMA also advises organizations to collaborate with vendors and coders within a clinical documentation improvement program. These programs can help stakeholders pinpoint problem areas and fix them as they happen.

    The guide explains that one organization was able to find $1.6 million in reimbursements that would have been overlooked if not for a collaborative program.

    With most healthcare system updates, some stakeholders may dread the addition of thousands of new ICD-10 codes. However, on-going training and audits can help to make ICD-10 implementation less burdensome and even increase hospital revenue.

    Dig Deeper:

    3 Key Steps to Continue ICD-10 Implementation Progress

    ICD-10 Claim Denial Rate Remains Low Among Most Providers