ICD-10 training: Staff will need to translate edits


That's the impression I got from SearchHealthIT's interesting Q&A with James Truesdale, partner at The Kiran Consortium Group, LLC and past program director for the ICD-10 Mandate at the Georgia Department of Community Health, about getting ready for ICD-10 implementation.

Here are two points that should worry the billing staff:

  • On not procrastinating:  "You will need to ensure your coders are familiar with the new codes. Hence, you do not want to wait until the last minute to train your staff to undertake any changes to bill payments."
  • On revenue impacts: "There will be increased payment delays from payers as well as overall decreased cash flow. Last, there will be increased documentation requests to substantiate medical necessity."

The training can't be underestimated. Not only do medical coders need to understand the code sets, but the billing staff needs to be ready to translate edits from healthcare payers.

One of the lessons from the HIPAA 5010 transition was that deciphering reasons for medical claim rejections took a lot of time. Just getting hold of someone at the payers' offices was an arduous task.

There is no reason to believe that the ICD-10 transition will be any smoother.

Also, Truesdale says that there will be more documentation requests from the payers. This seems to contradict other predictions that the specific medical codes will negate the need for more documentation requests. Maybe in the beginning, healthcare payers will want proof that supports the specific codes.
 

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