Recent studies based on current client data show that the revenue cycle of some hospitals are projected to see an impact of a negative 2-3% on net revenue with the implementation of ICD-10-PCS coding. HSMN in working with its client base has found that clients are counting on tools and systems rather than experience, training, medical staff behaviors and critical thinking skills. Each ICD-10-PCS procedure code is unique and not found in a book and therefore coders will build the procedure code based upon the clinical documentation in the clinical record.
HSMN has found that often physicians order procedures that are not performed, at least not in the way they are ordered. The second most profound event is the one in which the scheduler does not understand what the physician is ordering and therefore cannot properly apply a code that will be authorized. Compound these two events and revenue will fall, or at least be denied and may never be recovered.
HSMN has developed a program and methodology for both clinical documentation improvement and training coders in critical thinking skills as they apply their training in ICD-10-PCS to creating an appropriate code. The new game demands that coders think about what they are doing not just look up a code in a book. Physicians who already have trouble with doing accurate clinical documentation especially in the area of “specificity”, will encounter a “brick wall” when it comes to documenting for ICD-10-CM and ICD-10-PCS because the level of specificity is so high. In the new coding scheme there is no correlation between specificity and payment. In other words doing a better job doesn’t bring the hospital or physician any more revenue but each group can lose revenue.
HSMN’s Start 10 program encompasses detailed working sessions with the medical staff using the “Case Conference Methodology” developed by its physician advisors and coding team. In its methodology “clinical documentation equals reimbursement”. Current cases are “deconstructed” and then reconstructed from ICD 9 to ICD 10. HSMN presents recent cases to the medical staff of particular departments and provides a way for them to learn how to be specific.
HSMN then works with the coders to detail their understanding of the clinical work in a particular service and then brings the two groups together to discuss and review current cases and simulate them in ICD 10.
This is a good time to begin to take positive action not only for the Clinical staff and the Coders but also for all personnel that touch demographic and clinical data. Everyone in the revenue cycle stream must have a basic understanding of the difference between the two and experience in analyzing cases for billing purposes.
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