ICD-10 Compliance: Documentation is Everything in a Claim Submission

Health insurance claim formIn a hospital, an urgent care center, a family doctor’s office, a specialist’s office, and any healthcare facility, documentation is everything when submitting a claim and ensuring the integrity of patient care. If documentation is not accurate, thousands of dollars can be lost in denied claims. Documentation errors can also be the source of compliance issues that lead to very expensive legal issues.

Reducing errors and ensuring compliance are reasons why ICD-10 is important. Documentation will have to be improved to be compliant and ensure that as little money as possible is lost in denied claims and errors.

Getting Documentation Ready for ICD Conversion

The most important step that can be taken to prepare for implementing ICD is to start now if you haven’t already. Get professional assistance to ensure the integrity of your in-house billing so that you can avoid costly errors. If you start getting ready now before the October 1, 2014 ICD-10 compliance deadline, you will be ready to do the following:

  • Complete accurate medical records that ensure patients are given the right treatment.
  • Acquire the information that medical coders need to assign the proper medical codes, resulting in fewer physician queries so that clinical workflows and medical billing are improved.
  • Have adequate documentation so that medical claims are not rejected and down-coded. Claims that are properly coded are less likely to be denied. If they are denied, medical coders can better appeal denials.
  • Protect against healthcare fraud by improving clinical documentation.

Clinical documentation improvement (CDI) is a must in making sure computer access systems (CAC) work for healthcare providers. CAC systems rely on thorough documentation. If documentation is not thorough, the system doesn’t provide much assistance. CAC systems are currently being sold very aggressively as valuable tools in the medical field. If physicians are not willing or able to collect the right information from patients, then the systems won’t be as valuable and that can be quite costly.

Are You Ready for ICD-10?

At 2013’s American College of Physicians annual meeting, data showed that nearly 65% of clinical documentation doesn’t contain enough information for coders to be able to bill under ICD-10. According to a survey performed in 2013 by the Medical Group Management Association (MGMA), it was found that 40.9% of practices were “somewhat ready” and 38.4% said they had not yet started the ICD conversion from ICD-9 to ICD-10.

Here are 5 signs that documentation is not ready:

  • The hospital or health system is having difficulty improving comparative mortality data. Issues with data tend to be due to inaccurate documentation. Improving documentation can reveal the correct numbers.
  • The CDI program is not being actively monitored in order to create a benchmark. It is difficult to improve what isn’t measured.
  • The medical staff feels that accurate documentation is more of a revenue cycle program.
  • There are no dedicated clinical documentation specialists employed by the office or facility.
  • There is a heavy reliance on computer-assisted coding to solve ICD-10 documentation issues.

Staff Impact of Insufficient Documentation

At this point, many healthcare providers have experienced a number of issues in regards to insufficient documentation. Those issues have involved compromising patient care, impeding research, failure to improve public health tracking and reporting, and a number of others.

When documentation is sufficient, patient care improves, research improves, much insight is gained in the setting of health policy, public health is improved through better reporting and tracking, monitoring of resource utilization is improved, and room can be made for new procedures and techniques.

Clinical, administrative, and financial performance also benefit. The quality data that ICD-10 affords healthcare providers gives real insights into care patterns. In fact, payment accuracy is achieved because the risk that claims will be rejected due to incorrect coding is reduced greatly. Every element of a practice or facility will become more productive, having a positive impact on patient care and employee attitudes.

Payer Focus Will Change

Ensuring everything is in place by the ICD-10 compliance deadline will minimize claim denial. Due to the new code, payers are going to scrutinize claims even more. They are going to look for insufficient documentation so they have a reason to deny a claim. For the healthcare provider, this cuts into profits. Too many instances of insufficient documentation and the provider will begin to feel the burn from the denials.

By Implementing ICD, the need for payers to request copies of medical records will be reduced and give them fewer reasons to deny claims. The specificity within ICD-10 codes is much greater and will give the payers more insight, reducing the need for medical records to be requested, thus reducing costs.

Contact MD Pro Solutions today for your ICD-10 documentation readiness assessment. Fill out the form on our contact page or call Greg Keilliher at 508-923-7610 and take the next step toward improved documentation that will lead to smoother operations, lower risks, and higher revenues.