Is Your Practice ready for the end of the “grace period for ICD-10” on October 1, 2016? Is your 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. That equates to payment delays and decreases to your reimbursement. What can you do to prepare for the end of the grace period?
What is the October 1st 2016 grace period?
Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (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 if the codes were in the correct “family of codes”. The grace period however ends on October 1, 2016. Practices can expect to see denials and delays in payments as requests for medical records and clinical documentation will undoubtedly increase.
Is Medicare going to phase in the requirement to code to the highest level of specificity? 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 National Coverage Determinations (NCD) and Local Coverage Determinations (LCD). CMS has updated FAQ read about it here.
What three steps can your practice do to prepare for the ICD-10 storm that hits October 1, 2016?
- Conduct an Internal Audit of your Top ICD-10 Codes
- Review Your Clinical Documentation to Ensure Highest Level of Specificity Is Supported and No Money is Left on The Table
- Hire A Certified Professional
The Average denial rate of claims is 15%. Add the complexity of ICD-10 and the potential revenue loss is staggering!
Beware, having an EMR software does not ensure compliance. Encoder trees if uncorrected or glitches can lead to reimbursement delays. Will contracting with an independent certified and 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 directly for a complimentary consultation firstname.lastname@example.org or call our office at (516) 771-7554.