Small contributors Might struggle as ICD-10 grace period ends up

With the Saturday enabling the 1-year anniversary of the execution of ICD-10 codes, healthcare agencies must now concentrate on some latest needs that went into effect on the day of October 1. Small contributors might struggle as ICD-10 grace period ends up.
While the transformation from ICD-9 version codes universally is believed to be an unqualified victory, the ICD-10 grace period has finished, and the Centers for Medicare and Medicaid Services (CMS) no longer will be embracing unspecified codes on Medicare fee-for-service claims. The year of coding flexibilities that CMS agreed to previous year in he collaboration with the American Medical Association (AMA) has expired and won’t be expanded.
Although, as the agency noticed in guidance released in the month of August, the end of the ICD-10 grace period should not be a huge deal for contributors, as several commercial health insurers didn’t provide contributors any coding flexibility, needing them to use particular ICD-10 codes. Besides, CMS claimed, healthcare agencies “should already be coding to the largest level of specificity” and “should code claims to the degree of specificity reinforced by the encounter and the medical documentation.”
Moreover, Sue Bowman, senior director of coding policy and agreement at the American Health Information Management Association (AHIMA), asserts that the grace period merely implemented to Medicare fee-for-service claims from physician or other practitioner claims billed under the Medicare Fee-for-Service Part B physician fee schedule.
The grace period “didn’t apply to hospitals, so it does not impact anything hospitals are doing going forward on the day of October 1, and even from the physician standpoint it was restricted in its affect because it merely applied to post-payment reviews,” claims Bowman, who adds that “most persons have been having to do the largest degree of code specificity over the last year anyhow, regardless of the flexibility.”
Beginning on the day of October 1, CMS review contractors will “utilize coding specificity as the reason for an audit for a refusal of a reviewed claim” and they will “notify contributors of coding problems they identify during review and of steps required to correct those problems,” the agency claims.
On the other hand, Debi Primeau, president of revenue cycle consultancy Primeau Consulting Group, considers that the end of the ICD-10 grace period is “not a huge deal for acute-care hospitals, which have implemented retrospective and/or concurrent audits,” but it “might be a bid matter for smaller physician groups and individual practices.”
Primeau compels that physician groups and practices “haven’t actually been aggressively auditing to recognize either their physicians are utilizing unspecified codes.” She also mentions the fact that several practices don’t have coding experts but are rather utilizing drop-down boxes in their EHR systems to select codes.
“If they’re in hurry and do not actually understand codes, these practices might be choosing unspecified codes, and because several of these agencies haven’t yet performed coding audits, they really do not know if there is an issue or not,” adds Primeau, who largely suggests coding and documentation audits. “What we are discussing about is recognizing opportunities where you can concentrate on denial prevention versus denial management.”
Overall, Bowman claims she does not hope adverse consequences as an outcome of the end of the ICD-10 grace period. Nevertheless, Mary Beth Haugen, CEO of Haugen Consulting Group, is not as optimistic.
Primeau’s worry going forward is health insurers—not merely Medicare but commercial payers, who might start to adjust medical policies deployed on the latest specificity provided by ICD-10. “They have been gathering data for a year, and now is their chance to go back and recognize where some of these unspecified codes have been utilized and to begin denying claims,” she adds. “There are many commercial payers out there, and they have been data mining. They have seen bills that have been submitted for the previous year, know what is going on, and who is and isn’t submitting unspecified codes.”
For its part, AHIMA is motivating healthcare agencies to sustain to monitor their documentation and work to make better it when essential, Bowman claims.
Furthermore, she points out that CMS has lifted the partial code freeze, and as an outcome, thousands of latest ICD-10 diagnosis and procedure codes have been added for fiscal year 2017, which start on the day of October 1.
CMS claims in its guidance that the yearly update to codes is not a new procedure, as “codes were daily updated on an annual basis until a freeze was developed to help providers and health policies to prepare for ICD-10.”