The end of the “grace period for ICD-10” is on October 1, 2016. Is you’re billing and documentation ready for the ICD-10 Storm?
Practices that submit unspecified ICD-10 codes after October 1, 2016 may experience an increase in claims rejections. Rejections mean a decrease and/or delay of payment.
What is the October 1st 2016 grace period?
CMS and the AMA in an effort to assist providers with transitioning to ICD-10 in October 2015 enabled a “grace period” where claims submitted to CMS would be processed and not audited or rejected in the codes were in the correct “family of codes”. That grace period however ends on October 1, 2016. Practices can expect to see delays in payments as requests for medical records and clinical documentation will undoubtedly increase.
The most common question we have received is:
Is Medicare going to phase in the requirement to code to the highest level of specificity?
According to the updated FAQ released by CMS the answer is NO!
ICD-10 flexibility and grace period was for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of the ICD-10. That grace period however ends on October 1, 2016.
“Providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines”
What three steps can your practice do to prepare for the ICD-10 storm?
1. Conduct an Internal Audit
Review your top ICD-10 codes and determine if unspecified codes are included. Include CMS LCD and NCD.
2. Review your clinical documentation
Does your documentation support your coding to the highest level of specificity? Are there deficiencies? Are you leaving money on the table? Remember, having an EMR or E HR does NOT ensure compliance.
Some glitches in EMR software and encoder decision trees have been reported. These errors, if left uncorrected, lead to claims rejections and reimbursement delays. Examples of specific encoder software issues that have been identified include these three ICD-10 diagnoses areas:
3. Hire a Certified Professional.
The average denial rate of claims is 15%. Add onto that the complexity of ICD-10 and the revenue is staggering!
A credentialed specialist will not only help with reducing denials but they will identify money that may be left on the table. If the cost of a FTE isn’t an option, hire an independent consultant on a contract basis.
Will a certified credentialed professional cost more than a biller/coder that is not certified? Yes, but remember, “If you think it’s expensive to hire a professional to do the job, wait until you hire an amateur.”
Our certified and credentialed professionals at Precision Healthcare Consultants help practices for short term and/or long term projects. Contact me for a complimentary consultation or call our office at (516) 771-7554.