Electronic Health Reporter

Guest post by Amy Sullivan, vice president of revenue cycle sales, PatientKeeper. 

The multi-year run-up to the ICD-10 cut-over last October had a “Chicken Little” quality to it. There was prolonged hand-wringing and hoopla about the prospect of providers losing revenue and payers not processing and paying claims – the healthcare industry equivalent of “the sky is falling.”

Then CMS helped calm things down by announcing last July (as the AMA reported at the time), “For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.”

Since ICD-10 is all about specificity – the number of diagnosis codes increased approximately four-fold over ICD-9 – this was a big relief to all involved. And, if you believe new research data, the sky indeed has not fallen: Sixty percent of survey respondents “did not see any impact on their monthly revenue following Oct. 1, 2015… Denial rates have remained the same for 45 percent of respondents. An additional 44 percent have seen an increase of less than 10 percent.”

Still one has to wonder what will happen after Oct. 1, 2016, when the current leniency expires and ICD-10 code specificity is required. Will physicians be in a position to enter their charges completely and accurately once “in the general neighborhood” coding no longer suffices?

They will if their organization has invested in technology that adheres to best practices in electronic charge capture system design. The three watch-words are: specialize, simplify and streamline.

A charge capture system is specialized when it exposes only relevant codes to physicians in a particular specialty or department, and when it provides fine-tuned code edits.  With different types and processes of workflows (and let’s face it, personal preferences), physicians need an intuitive and personalized application that easily fits into their individual work styles. A tailored user experience allows providers to build and display their patient lists in whatever way is most convenient and meaningful to them – down to lists organized by diagnosis and “favorites.”

Charge capture is simplified when it lets physicians enter charges on the device of their choice – a computer in the office or at home, a smart phone in the car, a tablet anywhere – and when it gives physicians the ability to use familiar clinical terminology to look up codes. Dictionaries like the one produced by Intelligent Medical Objects (IMO) need to be thoughtfully integrated into a provider’s charge capture solution so it’s possible to easily reach the level of diagnosis complexity that will be required after next October’s deadline. Also, physicians need the ability to view and select the appropriate clinical codes knowing their selections will be mapped to the appropriate billing codes upon submission. In addition, it’s important for them to have point-of-care code edits, which leads to a reduction in coding errors. Having the ability to accurately specify codes in real time means fewer changes downstream for the administration staff, less time spent on research and follow-up of charges, and fewer instances of costly re-submissions and missing the claim-submission window.

Without up-front edits, coders are often left having to input many more changes. Sometimes, a procedure is performed on a patient during an office visit. The reason for the procedure may be separate from the visit, but doctors would have a difficult time remembering to add the appropriate modifier. Coders would have to go back and ask them, and an investigation would ensue. But if a code edit flags this for the physician, he or she knows to bill for the procedure separately.

Charge capture is streamlined when it is integrated seamlessly into physicians’ workflow via the electronic health records (EHR) system, and into the finance staff’s workflow via the billing system, necessitating fewer clicks, taps and swipes by all users. Also, by using “macro” functionality tools, an organization can capture charges simply and reduce the number of clicks that physicians experience. A set of charges, modifiers and diagnosis codes are grouped together and entered with a single tap or mouse click. This type of functionality eliminates confusion, saves time and ensures all services are billed.

Of course, knowing the general criteria for a solution is not the same thing as having one. The onus is on billing and revenue cycle managers to equip their organizations with tools that fit the bill. The primary objective should be to enable physicians to enter charges as accurately and completely as possible, as close to the point of care as possible. That gets the entire billing process off on the right foot, which ultimately benefits timely collection and revenue.

A provider organization that is appropriately equipped should not face any more difficulty on Oct. 1, 2016, than they did on Oct. 1, 2015. And when they look up at the sky on that day, all they’ll see is sunshine.