Last October marked a considerable milestone in the healthcare industry, and as organizations settle into the change, there are a few key programs to keep on the books to ensure your department’s coding success before October 2016 (when ICD-10 penalties will start), as well as in the coming years as we transition from fee-for-service to pay-for-performance reimbursement models. In a recent white paper, we detail those programs at length, but below, I’ve have provided a quick, at-a-glance look at a few critical programs to have in place right now to ensure the coding success of your organization in the future.
Ongoing ICD-10 Training Program
As much as your organization prepared for the ICD-10 go-live in October, ongoing training is just as, if not more, important. Understanding what code sets your facility uses most often and what codes your staff struggles with the most and finding opportunities for continued coding education are great ways to maintain coding efficiencies.
Great ways to ensure your team has everything they need is to:
- Develop and continually update quick-reference guides with ICD-9/10 coding fundamentals
- Recognize and deploy the most appropriate training delivery methods; i.e. workshops lunch and learns, online seminars, self-study tools, etc.
- Develop education tools and resource database, with access to Case Studies, User Manuals, Technical Guides, and Video Tutorials
- Identify any need for more advanced coding education in complex specialty areas
Clinical Documentation Improvement (CDI) Program
If you don’t already have one, implementing a CDI Program to supplement your coding initiatives may be one of the most important things you can do to promote (1) a healthy relationship between your physicians and your coders and (2) improve documentation accuracy, resulting in higher reimbursement rates and better population data. CDI Programs can be difficult to initiate, depending on an organization’s culture; however, I suggest the following approaches to make program development smoother:
- Form a committee with various enterprise stakeholders—p.s. this should include one representative from EVERY department; coding accuracy effects the entire organization
- Bring on at least one CDI Professional and one Physician Liaison to help develop program milestones, workflows, and help ease any tension between clinical and coding staff members
- Develop clear policies and procedures
- Begin creating customized template queries for your CDI personnel
Regular Coding Audit (Internal & External) Program
Just like death and taxes, coding audits are inevitable. The best way to prepare is to practice, just as we would for anything else in life. Randomly extracting records, reviewing them for coding and clinical accuracy, and having a transparent conversation with your clinical and coding teams about the importance of thorough, accurate coding can go a long when the big guys come knocking (ZPIC, RAC, MAC).
Want to know another proven way to prepare for a medical record audit? Have someone check you work! Again, just like anything else in life, having someone, whether a sister department, partner, or vendor, check your work by doing a mock audit will show you things your team may have overlooked. Things the external government auditors won’t overlook.
Again—couple of approaches to seeing this type of program through, but the importance of mock audits, whether internal or external, cannot be overstated.
RCM Metrics Reporting & Analytics Program
Fairly new-to-market is the use of RCM analytics. I’ve talked to it before in a blog, and it’s definitely gaining traction, and giving a lot of useful coding data into the hands of RCM professionals. Of course, in any RCM/HIM environment, constant monitoring of financial and operational states is important; before, we’ve done this by deploying organizational and industry benchmarks to see where we are and stay on par with expected reimbursement outcomes. With the implementation of ICD-10 and more complex coding requirements, quality requirements, and coding accuracy, simply monitoring benchmarks may not be enough to stay competitive. Reimbursement analytics and metrics enables the organization to streamline processes for improved staff efficiencies and faster reimbursement so that RCM and HIM leaders can quickly identify and respond to changes in an increasingly competitive market.
