In the world of western medicine, better outcomes may be the objective, but financial health—for patients and service providers alike—is the domain of the insurance industry. Coding for prompt, proper reimbursement from payers is already challenging, because profits are predicated on denials, and improperly-coded services just don’t get paid. Like it or not, accurate codes are the keys to the kingdom, and the number of keys is about to quadruple.
ICD-9 has been around for about thirty years, and it’s getting long in the tooth. Rapid medical advancements in diagnostic and remedial capacity have long since exceeded the capabilities of the code set, and coding for reimbursement has become an art as much as a science—a kind of medical haiku that masks as well as illuminates. ICD-10 has been developed to correct this problem, with greater specificity and structural enhancements that will enable precise coding without the haiku. ICD-10 has already been implemented in many nations around the world, and it has been mandated for use in the United States beginning late in 2014.
Unfortunately, the scope of this change is enormous, and the transition to ICD-10 will affect every part of your practice, from operational processes to back-office billing. Your systems will change, your information technology will change, and the burden on your medical and actuarial staffs will be substantial. Make no mistake: the transition to ICD-10 is going to require one of the longest and most intense learning curves in the history of the healthcare industry, and your revenue stream will be impacted. The trick is to minimize the impact in the short-term, and benefit from the changes in the long term.
Every service provider will require assistance to make this transition—in consulting, in training, and in technology. Technology in particular will prove to be a crucial asset, and you will find that you can minimize transition costs with thoughtful technology investments. Chief among these investment options is Computer-Assisted Coding (CAC). Modern CAC systems have come a long way from their forebears, and today utilize advanced technologies such as natural language understanding and contextual analysis to decipher and extract remarkably accurate coding from medical records. The proposition is simple: use CAC to automate the rote, mundane, and repetitive aspects of coding, and reserve your valuable coding staff for the more complex cases. Oversight is preserved, manual labor is reduced, time is saved, and costs are lowered. It’s an attractive option for an overworked coding staff.
More significant is the fact that CAC is an elegant and effective way to ease the transition to ICD-10. Many CAC systems are already ICD-10 compliant, and can be used as a vital educational tool for your coding staff during the transition. Specifics will vary from practice to practice, but as a practical matter, both code sets will be needed for a period of time. CAC systems can provide immediate ICD-10 coding expertise, allowing your staff to compare and contrast coding methods. They can provide a reference point for the development of training materials using live clinical data, thus assuring contextual familiarity for coding staff and physicians alike. The training curve will be smoother, shorter, and less costly. Payer compliance will improve, and documentation and reporting requirements will be fortified.
Implications for Professional Staff
It is important to understand that modern CAC systems do not replace professional coders, nor are they intended to. CAC systems have become extremely accurate, but no system is perfect, and any technology must remain subject to professional oversight, regardless of sophistication. CAC assists the professional coder with automation, and reinforces best practices with reliability and consistency. It is not a final authority. The productivity of your staff will certainly increase, but then the workload associated with ICD-10 is also going to increase. CAC will help them to cope; it will not replace them.
CAC has a enjoyed a rapid growth in modern healthcare delivery systems because it provides crucial, undeniable benefits to practitioners and service providers. These benefits will accelerate with ICD-10. They include improvements in:
Accuracy: CAC systems offer most organizations a substantial improvement in coding accuracy. Many systems today claim first-pass accuracy rates in excess of 97%. Better accuracy means fewer denials, fewer auditing discrepancies, and more time to unearth and correct lost charges. This will be particularly important in the early days of the ICD-10, when susceptibility to coding errors is highest, and payer scrutiny is most intense.
Compliance: CAC systems will improve your payer compliance right out of the box. You’ll see fewer coding and billing errors, reductions in the risk of a charge of fraud, more accurate accounts receivable, and the ability to identify trends and problems that can be addressed through physician and staff education.
Consistency: Consistency is a fundamental component of any set of best practices, and automated systems provide the reliability and predictability borne of an algorithmic approach. The robustness of your coding processes will improve, and with it, the confidence of your professional coders and your actuarial staff, who can depend on more accurate results for both clinical and financial analyses.
Productivity: CAC will improve your staff productivity significantly. Hours spent manually coding can be substantially reduced or eliminated with excellent accuracy rates. Your professional staff can instead focus on complex cases and ramp up on the larger code set that ICD-10 represents—without the loss of throughput that you might otherwise expect.
Start Preparing Now
The transition to ICD-10 is big, it’s important, and it’s unavoidable. Compliance is mandatory if you want to get paid, and CAC can help ease the transition in numerous ways. Give us a call if you have questions about CAC and how it can help your practice to survive and thrive in the the coming months.