H.I.M. On 10: Coding Experts Sharing ICD-10 Insights

ICD-10 trouble spots emerge

In the How Well Do Your Coders Really Know ICD-10, ICD10 Monitor article from August 2015, I identified five best-practice steps to take during ICD-10 coding reviews and audits. As ICD-10 trouble spots emerge in November and December of 2015, coding managers should consider the following strategies to closely monitor coder knowledge, proficiency and performance.

read more

Second round of ICD-10 end-to-end testing indicates HIM’s hard work is paying off

CMS completed its second round of ICD-10 end-to-end testing April 27-May 1, and the results are in. The good news is that more than 88% of the 23,138 ICD-10 test claims passed with flying colors. Only 2% of rejections occurred as a result of ICD-10 coding errors. In fact, CMS cited various non-ICD-10-related errors as being the culprit of most testing denials. These errors include incorrect NPI, Health Insurance Claim Number, or Submitter ID; dates of service outside the range valid for testing; invalid HCPCS codes; and invalid place of service. This second round of testing comes in the wake of an almost equally successful first round held January 26-February 3, 2015 during which 81% of claims passed through CMS’ billing systems. I summarized two learning points for HIM and revenue cycle in my earlier blog on first round testing. HIM input invaluable in testing efforts Successful ICD-10 testing would not be possible without HIM’s expertise and input behind the scenes. HIM professionals provide the manually ICD-10-coded claims that make testing possible. They also help identify the types of cases most critical to an organization—those that would leave the organization financially vulnerable if not vetted thoroughly. Two ways to continue momentum CMS’ end-to-end testing provides valuable insight into potential denials and productivity bottlenecks. The final round will take place July 20-24, 2015. The agency plans to review applications for its last round of testing and select participants by June 12. Here are two ways to continue testing momentum and remain fully engaged in your organization’s ICD-10 journey. If your organization participated in the past, consider testing again to verify... read more

First Round of End to End Testing for ICD-10 Reveals Two Key Points for HIM and Revenue Cycle

Over 2,500 healthcare organizations participated in the first of three rounds of end-to-end testing for ICD-10 during January 2015. Different from acknowledgement testing conducted last year, last month’s end-to-end testing performed by CMS is expected to yield important insights for hospitals to know and understand as the October 1, 2015 deadline approaches. According to CMS, the results of January testing will be made public in late February 2015. At this point, two things are certain. More healthcare provider organizations needed for end-to-end testing The need for more testing participants became clear when CMS extended the deadline for healthcare providers to volunteer for the April 2015 round of end-to-end testing. At this point, volunteer organizations have been selected are should be receiving notifications from their MACs and Common Electronic Data Interchange (CEDI). A third round of testing will occur in July 2015. Washington is wary of another failed technology implementation in healthcare following the well-publicized, botched rollout of Healthcare.gov. Healthcare providers can do their part in making the ICD-10 transition a success by actively preparing and testing with CMS. Now is the time to get involved and get testing. Test with real cases and dual coding End-to-end testing is most effective and accurate when conducted using real cases that have been dual-coded in both ICD-9 and ICD-10. The use of real, dual-coded cases (versus generic equivalency mappings-GEMS) sheds light on important documentation gaps, coder knowledge deficiencies, system interface failings, and claims submission flaws. Furthermore, testing with real cases provides valuable feedback for CDI and coding teams. It identifies an organization’s specific vulnerabilities for revenue loss and claims denials under ICD-10.... read more

Coding Goes Global to Meet ICD-10 Demand: Three Key Takeaways

When hospitals ratcheted up their coding resources in 2014 for the implementation of ICD-10, they also began evaluating international coding options for back-up support. Some providers directly contracted with offshore coding teams. Others partnered with U.S. based coding companies with International presences to “test the waters” in India, Philippines, Israel, the Caribbean and more. Certainly, the one-year delay gave all parties additional time to experiment, evaluate and experience what Thomas Friedman originally coined “Globalization 3.0.” In his best-selling book,The World is Flat: A Brief History of the Twenty First Century, Friedman clarifies, “I did not mean that the world is getting equal. I said that more people in more places can now compete, connect and collaborate with equal power and equal tools than ever before.” That’s why an Indian in Bangalore can take care of the office work of American doctors or read the X-rays of German hospitals. And considering the existing coding shortage, this is a good thing. Most hospitals have dipped their toes into international waters and worked with offshore coding teams. What have we learned? Here are three “global” points to keep in mind: 1. You Open Up the World Once you open up access to the world, the world has access to you. For healthcare providers, overseas opportunities are not just about purchasing a service; they are also about providing professional expertise. From IT directors to administrators and managers, U.S. healthcare professionals are migrating to other countries for higher pay, deeper incentives and to gain international experience. Even U.S. healthcare organizations, such asCleveland Clinic andJohn’s Hopkins, are now service providers for global hospitals. TAKEWAY: Your... read more