With the ICD-10 delay, many Practitioners have shifted their focus from correct and specific diagnosis coding. However, there are many other forces at work here, correct and specific diagnosis coding is imperative in the changing reimbursement environment, and to prepare for ICD-10. Physicians have largely ignored diagnosis coding for years because, unlike hospitals, they did not get paid on that basis. As long as they had a valid diagnosis code, they were paid based on their CPT code with no variation for severity of illness. This often encouraged them to choose just one code and the easiest, simplest one they could find. This did not present a complete picture of that patient, but there was no incentive for them to take the extra time to document and code the patient's co-existing conditions.
ICD-10 is just one reason to improve diagnosis documentation and coding. Many payers are basing reimbursement on the health of the patient, and that cannot be accurately measured without specific diagnosis documentation and coding. Unrelated to ICD-10 implementation, the Affordable Care Act instituted risk adjustment provisions on insurance companies - these provisions are based on the diagnosis codes that have been filed on claims. But, as noted above, physicians have not been very specific. So, now, insurance companies are pressuring physicians to code more accurately and more specifically - but many are not prepared to do so. This is unrelated to the ICD-10 deadline or the delay, but improving the documentation and coding in ICD-9 will provide for a smoother transition to ICD-10. This will also provide for a more accurate picture of each patient's health and will make quality reporting more accurate and complete.
Join Kim Garner-Huey - MJ, CPC, CCS-P, PCS, CPCO in this session to get an explanation of risk adjustment - impact to insurers and the resultant impact on providers.
Topics covered in the session:
Who should attend:Physicians and other providers, coders, billers, managers
Kim Garner-Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC, is an independent coding and reimbursement consultant, providing audit, training and oversight of coding and reimbursement functions for physicians.
Kim completed three years of pre-medical education at the University of Alabama before she decided that she preferred the business side of medicine. She completed a bachelor’s degree in health care management and went on to...
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