Stay ahead in the medical coding game with these benefical insights.

We see a lot of unprecedented reforms in the healthcare industry every month and every year. The complex healthcare industry has limitless discussions every minute. From ACOs to ICD-10 to fee-for-value, the voices are loud and clear, it the burdened physicians who are having a hard time fighting these transitions. And yes, the Game of medical coding this year will certainly have an impact on medical practices revenue.

Transitioning from paper records to the pixel world and a complex coding system, medical practices had to work beyond the 8 hours a day. ICD-9 is numeric and ICD-10 is alpha numeric, which has forced the coders to boost up their learning before the October 1^st switch and the need for a certified coder on board!

The reform in medical coding…

There was a time when medical coding was essentially about converting narrative clinical data into a set of alphanumeric codes. Now, there is increasing need for capturing medical data into a format that is universal, standardized, and data that can be deciphered by individuals and systems across the healthcare continuum. It has to have a meaning, at an individual and collective level.

The transformational changes in the coding field have given rise to newer challenges and bottlenecks. The granularity in data and universal coding methodologies it demands, has forced medical practices to roll with the punches and allocate more time and resources, towards a procedure that hardly was a cause for concern earlier on.

The October 1st deadline, only 75 days to hit…

ICD 10- the game changer !

The biggest roadblock that physicians face is ICD10. It is expected to bring major cash flow and operational disruptions. Coding professionals should be proficient in almost 155,000 codes. Pristine documentation is required to assign codes that are several times more specific than its timid cousin ICD 9. Medical codes should be assigned to the highest level of specificity and supporting medical documentation has to be errorless.

Medical coders should be aware of the medical necessity guidelines followed by payers and the level of specificity insurance companies demand. Expert and certified medical coders are in demand to test ICD 10, run analysis and comparison reports between the two coding systems, perform dual coding, and identify documentation insufficiencies and inaccuracies prior to the ICD 10 roll out.

The need for sustained quality of clinical documentation…

The penalties for not complying with CMS’s quality reporting program started this year and those participating in 2015 will see the effect after 2 years, in 2017.To prevent reduction in reimbursement, coders should double up as documentation specialists as well. Their jobs will move beyond chart abstraction and interpretation. Medical coders should ensure that medical documentation for coding is continually updated and in compliance with CMS guidelines.

Medical information has to be entered into a standard database and the coding professional should understand clearly how the accuracy medical data is represented in codes sets.

Understanding the cost of implementation and time consumed…

The cost of transitioning will be huge and will include but not limited to, implementation of new software, training physicians and coders on the transitioned codes and upgrading and testing your systems, for October 1st. Revenue cycle experts estimate the upgrading the health systems would cost $15million. Medical practices have to train their physicians and staffs through webinars, Provide professional practice resources and author professional journal articles. Medical practices and vendors have to work together on their IT systems to upgrade and comply before the deadline hits.

It is high time you get a professional!

The first step in mastering ICD-10 is to become familiar with the terminology, structure, and format of this new code set. Most of the practices have decided to go live in October even if the government has to extend the deadline. Implementation specialists say it is the training of coders that has delayed the updating process.