The Coding Institute Experts Say - Make Best Use of Extended ICD-10 Training Time

Despite the delay in implementation, experts warn that practices must continue their efforts to prepare for ICD-10 use.

According to a study by Aloft Group in March 2014, nearly half of healthcare providers in the US have completed only 25 percent or less of their ICD-10 implementation plans.  The ICD-10 delay – therefore – is welcome news to many providers.

Providers should view the ‘delay time’ as practice time for detailed documentation – an opportunity to boost new skills. “Of note, we should not throw away the chance to improve the physician’s clinical documentation just because the code set implementation has been delayed,” says Barbara Cobuzzi,  MBA, CPC, CENTC, CPCH, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J.. “It is always a goal to improve clinical documentation,” Cobuzzi adds.

To make the best use of the extended training time, providers should stay focused and take these steps:

·         Maintain the momentum towards ICD-10 readiness

·         Keep tabs on the most frequently-reported ICD-9 codes

·         Devise a top-25 list that will help guide you to the most relevant chapters in the ICD-10 coding manual

·         Focus only on the codes you are most likely to use – All the codes don’t apply to every specialty.

·         Boost your documentation skills – particularly in your focus areas so that by next year, your records will regularly include the kind of detail coders will need.

·         Become familiar with the new coding concepts.

·         Know all of your “points of contact” for ICD-10

·         Ensure practice management/EHR systems can handle the transition.

Providers should also take advantage of various training resources available from AHIMA, CMS, The Coding Institute and other organizations.

Training should be specifically targeted to the conditions physicians handle on a daily basis. The Coding Institute (TCI) offers various ICD-10 training resources through its website, where providers can access ICD-10 charts, newsletter, crosswalks based on general equivalency mappings, and other tools. Last week, the company launched ICD-10 Multispecialty Guide - a Quick-Reference Guide for 23 specialties - to help medical practices in jumpstarting their conversion to ICD-10.

Hospital Billing 2014: CMS Instructions on When Part B Inpatient Billing Applies

Part B inpatient billing is not always top of mind for hospital coders, however the Federal Register outlining IPPS polices for 2014 has addressed this topic. Here are some dos and don’ts of Part B Billing.

When Does Part B Billing Apply in a Hospital Setting?

Part B billing applies in a hospital setting when an inpatient admission is judged as “not medically necessary” after the patient has been discharged. If the inpatient admission is determined as not appropriate, while the patient is still in the hospital, then Condition Code 44 is used and the billing changes to Part B outpatient. Again you cannot bill for observation because a physician has to order observation and this would take place right at the end of the hospital stay.

Watch your steps: In two occasions a determination can be made for the inappropriateness of an inpatient admission after the fact: Firstly when Federal or RAC audit determines inappropriateness and secondly when the hospital, through a self-audit process, determines inappropriateness.

For more information on coding under Condition 44 circumstances, refer to this article featured in Inpatient Facility Coding and Compliance Alert.

Timely Filing – Your First Barrier

For Part B billing, it must be done within the timely filing guidelines for the inpatient admission. i.e, one year from the initial claim. However, a RAC audit may be conducted after one/two/three years after the inpatient services. If the RAC determination holds up and the inpatient admission is determined not medically necessary, then there’s no option in Part B inpatient billing if you are not inside the timely filing guidelines. Therefore, the main time this billing procedure will be used is when the hospital determines the inpatient admission as medically necessary, through self-audit.

Part A Should be Billed First

Not sure how to generate claims for the Part B billing? The Centers for Medicare and Medicaid Services (CMS) instructs you to file a Part A claim on a ‘No Pay/Provider Liable’ basis. Once the Part A claim denials reach your system, you can go ahead with the Part B inpatient claim.

                                                                                              

Don’t Bill Part B if Services are Inherently Outpatient

CMS instructs you to file Part B inpatient claims for services that are not inherently outpatient. As such, you cannot bill observation of services through this process.