While looking to the next year, the practices should start being proactive with these coding opportunities now to consider how the following top five key factors will affects the documenting, coding and billing for care…
5. Documentation and coding precision
While precision and accuracy has always been important, its significance is unparalleled now because of 2 dynamics:
Instead of attempting to save time by utilizing a cut-and-paste documentation approach, a better technique is to permit physicians to rapidly capture discrete information in the electronic health record (EHR) using the advanced documentation functionality of software while giving the flexibility to add unstructured notes when essential.
The claims denial rate is perhaps considered to be the best indicator that a practice is documenting, coding and billing rightly. If physicians are observing denial rates grow from their pre-ICD-10 baselines they should perform a careful assessment of how their care teams are capturing information and how coders and billers are accessing that data and billing for services.
However, denial rates might have stabilized since the ICD-10 transition, don’t be shocked if they escalate again as payers now have close to a year of ICD-10 data and start to establish more aggressive medical necessity models. For example, the Centers for Medicare and Medicaid Services (CMS) has dropped its previous grace period on unspecified ICD-10 codes.
It is crucial that practices understand the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)—and more particularly, the Merit-Based Incentive Payment System (MIPS). In accordance to the Deloitte Center for Health Solutions 2016 Survey of US Physicians, 50 percent of physicians claim that they have never heard of MACRA. This makes it important for entire practices, even those with some Medicare sufferers, to pay attention to the affect this bellwether legislation has on documentation, coding and reimbursement.
In result, MACRA/MIPS is CMS’ consolidation of the Physician Quality Reporting System, Meaningful Use and the Value-Based Modifier programs. Quality measures comprise over half of a physician’s MIPS point score, which makes it essential for practices to capture and code information accurately related to quality-of-care indicators. The revenue cycle staff should be tasked by practices with understanding MACRA/MIPS and setting practice policy. The MACRA/MIPS leader can collect instructional data about the program from physician-specialty trade agencies to educate the practice and execute processes to assist fulfill its requirements.
2. Training of Staff
MACRA/MIPS, ICD-10 and value-based care models in general need practices to take a more sophisticated approach to revenue cycle management than ever before. Elevating staff expertise to a higher level of coding and billing knowledge is important, but does not require being combated alone. Practices that outsource their coding and billing can establish powerful partnerships with their vendors. Those with internal coding and billing functions can switch to specialty societies for training.
Involving an experienced and knowledgeable individual to assess documentation and coding practices can also assist to optimize revenue cycle processes. So several changes are occurring quickly today that little appears to get more convenient for providers really trying to care for patients. Practices can drive improvements in coding, the revenue cycle and patient care by engaging everyone and working together as a team.
1. Team effort and cooperation
In everything from data capture to patient care, entire responsibilities can no longer fall alone on shoulders of physicians. Implementing workflows that permit clinical support staff to understand and share documentation duties, for instance, can reduce some of the burden from physicians.
Physicians and other members of the care team will have a convenient transition come 2017 by proactively preparing for these coding enhancement opportunities. On top of this, practices as a whole will analyze an improvement in not merely patient care, but in the fiscal health of their practice.