ICD-10 and Beyond Advice from Denny Flint and The Talon Group: Q and A
September 15, 2015
What can we do in the 15 days remaining until the October 1st implementation?
Dual code, dual code, and then dual code some more! This will uncover documentation and coding familiarity shortcomings. It will force providers to become aware of new specificity for their specialty.
What does Denny Flint consider as the ICD-10 “Biggies”?
- Laterality, Site, and Region!!! (even for Sciatica)
- Encounter type for Accidents and Injuries (Initial, Subsequent, and Sequela)
- Capture the comorbidities and complications (your future reimbursement depends on it!)
- External cause codes (don’t let this be a reason for denials)
- Don’t abuse or overuse the “unspecified” codes
- General physical exams (child, adult, gyn., etc.) with and without abnormal findings
- Tobacco History, Use, or Exposure additionally coded for many conditions
What metrics does my organization want to monitor after October 1st, 2015?
- Provider productivity
- Physician queries
- Coder productivity
- Billing and AR metrics
- Denial reports
What can our practice expect in the initial days and weeks after October 1st, 2015?
In the first few days, I believe the transition will be “clunky” but not chaotic. The “proof in the pudding” will be the payer response. Though not confirmed, I believe the government has put the payers on notice not to play games at the outset. Therefore, the payers will most likely phase in the chaos over time by carefully choosing how far they can push the envelope and when regarding the ramp up of denials due to diagnostic shortfalls (lack of medical necessity, lack of specificity, lack of additional codes required, etc.). So externally think “Y2K” in with a whimper and a bang. Internally it completely depends upon your implementation efforts to date and your provider commitment. Clinical documentation improvement is the key to ICD-10 success. Your processes adjustment is CRITICAL! (Are your waiting rooms backing up? Are your days in AR increasing? Then you have a problem!)
What is the next “Monster Under My Bed”?
The death of fee-for-service reimbursement that awards excess (according to the payers) and the rapid march toward Value-based or Outcomes-based performance models.
About Denny Flint:
Denny Flint is the principle consultant of The Talon Group. He formerly served as the CEO of a large, multi-specialty physician group, full service MSO, was certified as a CPC through AAPC and has authored or co-authored numerous “common sense” practice management books and implementation manuals. He is an award winning, nationally known consultant, speaker, and educator bringing his expertise to making the complex “simple.”
Educated at the United States Air Force Academy, Denny had a distinguished career as an Air Force pilot and has a long history of commitment to excellence and dedication to his clients’ success. Contact the author at dftalon77@gmail.com or (970) 390 8970.
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