Implement Operational Efficiencies During ICD-10 Delay

By Nancy Clark, CPC, CPB, CPMA, CPC-I

The Protecting Access to Medicare Act of 2014, or the sustainable growth rate “patch” bill, which was passed in April, effectively delayed ICD-10 implementation until at least October 2015.  However, that is no reason to delay the beneficial operating efficiencies that are related to the ICD-10 implementation.

One goal of ICD-10 implementation has been to improve documentation to better support the increased specificity of the ICD-10 diagnosis codes.   Medical record documentation is frequently targeted by auditors because it may not support the billed procedure code.   Increasing standards now will better serve providers by reducing their overall audit risk.  In addition, with health care moving towards quality of services instead of quantity of services, more complete documentation will serve to increase substantiation of performance measures.  These measures, such as the Physician Quality Reporting System (PQRS), can provide additional revenue for the practice and also mitigate financial penalties in future years.

According to the Medical Group Management Association (MGMA), documentation which better reflects the episodes of care will greatly assist in coordination of care. The quality of care provided during transitions of care, such as when a patient is referred to a specialist, admitted to a hospital, or transferred to a rehabilitation center, will be more complete, even if the patient is unable to recall specific events during his care.  MGMA also notes that with an increasing number of patients now requesting access to their medical records, it is essential to ensure the documentation’s accuracy.

Perhaps the improvement that will ultimately convince physicians to comply with documentation requirements is the increased billing accuracy.  It is generally acknowledged that many potentially billable services are not submitted to insurance companies for reimbursement because they are not documented, and therefore cannot be identified by the billing staff.

Continue to work on operational efficiencies during this ICD-10 implementation delay, and practices will reap benefits both during and after this extended period.