Billers & Coders to help with ICD-10 Conversion at Hospitals

The implementation of ICD-10 coding means facing the challenges of an unknown entity. When it comes to ICD-10 transition at hospitals, majority of employees across diverse functional areas – physicians, coders, nurse case managers, IT staff, financial services, billing staff, and administrators, to name a few – will be affected, requiring varying levels of education and training in clinical and revenue cycle operations. Moreover, the hospitals will also face challenges and significant changes to their operational, technology and financial processes.

Industry fact states

40% hospitals have not begun ICD-10 CM training for coding staff
55% hospitals have not begun ICD-10-PCS training for coding staff
47% hospitals have not begun document improvement education for medical staff
31% hospitals do not plan to dual code prior to Oct. 1, 2014

The pace at which hospital administrators, health information professionals and compliance employees are moving toward the ICD-10 transition has been the cause of concern in the healthcare industry. According to a survey, some 20% of small and mid-sized hospitals have not yet begun any education or training for ICD-10 transition.

Lessons to be learned for successful conversion strategy:

If the organization is not properly positioned to meet the ICD-10 conversion deadline, the organization should act upfront by analyzing the need and intensity of the situation. There should be no more delays in adopting for the transition. ICD-10 will be critical to the success of all healthcare organizations following the deadline.

Although ICD-10 presents complex concerns for small hospitals, there are specific opportunities for improvement through an efficiently executed ICD-10 assessment and implementation process. Taking a strategic approach to this process can help meet ICD-10 requirements within a budget, without compromising the quality of patient care or the efficiency of reimbursement procedures.

GAP analysis: Perform GAP analysis to understand how ICD-10 coding will impact each area within the organization. This will allow the organization to develop a road map of what areas need to be tackled.

Governance: As the organization proceeds toward ICD-10 transition, physicians will need to have a deep understanding of how the codes will affect their clinical documentation. While they may not be doing the coding themselves, they are going to have to be much more detailed in their clinical documentation. Hence, this can be a crucial step for the hospital while considering the transition.

Physician engagement: As the organization proceeds toward ICD-10 transition, physicians will need to have a deep understanding of how the codes will affect their clinical documentation. While they may not be doing the coding themselves, they are going to have to be much more detailed in their clinical documentation. Hence, this step will be more important for the hospital while considering the transition.

Budgeting: While implementing the transition process, the organization must set a budget for the following: training needs, IT upgrades, system remediation costs, consulting needs, coding audits and clinical documentation audits. This will be vital, as it is important to ensure that the hospital doesn't go overboard with their expenses.

Project management: Areas affected by this change include patient access, revenue cycle, physician documentation and patient care. The organization needs to hire a project manager for ICD-10 transition to coordinate all these activities.

Due to various challenges involved in the transition, hospital management is forced to restrict their hands while undergoing the transition. Moreover, the hospitals will also have to spend on getting their staff and technology upgraded to complement the ensuing ICD-10 standards in medical billing and coding. Here, billers and coders can prove to be of great help while managing the transition.

Billers and coders help perform ICD-10 assessment at the hospital

Small hospitals may be unaware of the extensive impacts and risks that an ICD-10 transition can have on its facility and operations. In such cases, billers and coders can help the hospitals in assessing ICD-10 solutions by performing a readiness assessment to identify areas in need of remediation, and also develop a plan and budget for the same.

Billers and Coders can ensure that the hospital is preparing for ICD-10 transition by following a thorough assessment to identify risks and opportunities in the following areas:

  • Operations – Billers and coders can consider the operational processes impacted by ICD-10 including coding and clinical documentation
  • Information Technology (IT) – Billers and coders can help in reviewing internal systems and the policies of third party vendors to smoothen the transition process
  • Finance – Billers and coders can help assess payer contracting, budgeting for ICD-10 implementation, and planning for the potential cash flow impact so that hospitals can adapt to ICD-10 transition efficiently

From determining the accuracy of coder skills to contingency planning, each level in an assessment can be crucial to the development of ICD-10 readiness and compliance, and the role of medical billers and coders will prove to be vital in handling the transition. – the largest consortium of medical billers and coders across all 50 US States is constantly updating their coders’ knowledge with ICD-10 transition techniques. Our unique training program on ICD-10 transition offers webinars, forums, and online learning materials, and latest updates – works towards making this transition much simpler and much more beneficial for both practices and the medical billers and coders.

We also help coders get access to the numerous upcoming ICD-10 and other opportunities through our job portal. Additionally MBC provides insightful advice on ICD-10, along with providing a regular online ICD-10 updates on tackling the upcoming challenges.

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