Should we fear change?

December 7th, 2016 / By Rebecca Caux-Harry

When it comes to regulatory changes, do we still have anything left to fear?  Oh sure, there are all kinds of changes coming for us, like the merit-based incentive payment system (MIPS) or the alternative payment model (APM) and Medicare Access and CHIP Reauthorization Act (MACRA), but I should qualify my question.  Do we still have anything left to fear regarding ICD-10?

 Fear is something I prefer to forget, but I can’t forget where we were a year and a half ago.  The entire industry feared a complete halt to claim payments due to payer systems not being ready, mountains of medical necessity denials, providers reaching the end of their rope with requests for more specific documentation and let’s not forget the fear of massive backlogs due to a significant drop in productivity and the threat of retirement of many seasoned coders. So what actually happened?

Regarding the halt of payments, that fear seems to have been baseless.  Payers were well prepared for our ICD-10 claims, probably because of the last minute implementation push-back in 2014 that frustrated all of us.  How many of you know exactly where you were when you heard the news?  I know I do!

CMS helped us out by giving us a year to practice our specificity by preventing denials of claims if the ICD-10 code was in the right family.  That grace period ended October 1 of this year. The industry was silent, at least to my ears.  I must admit, I expected some overhauls to medical necessity policies as a result of the end of the grace period.  I expected a gradual, or abrupt, removal of unspecified codes from the lists of payable indications for procedures with medical necessity policies. But that hasn’t happened. 

How about the providers?  Yes, I have heard quite a bit of frustration regarding documentation requirements from providers.  However, an interesting process is happening.  Facilities are taking over coding for professional claims all over the United States as a result of consolidation of services.  Hospitals are purchasing physician practices.  Professional coding is now either working with, or under the HIM department.  As a result, coding is now consolidated and so is the Clinical Documentation Improvement (CDI) process.  Queries from CDI reviewers now benefit both the facility and the professional coders, plus the providers only field queries from one set of CDI reviewers.  I’ve often heard from providers that they want one set of directions/questions from coding so they can comply and get on with practicing medicine.  Thankfully, that is happening now in many places.

That leaves us with the backlogs due to productivity and staff loss.  Well, we didn’t avoid that one entirely.  Thanks to the many training modules and sophisticated coding tools, productivity loss wasn’t as high as expected.  I talked to one practice that had done so much dual coding in preparation, that when October 1, 2015 came around, they actually improved their productivity as a result of only coding in one code set.  Now that’s prepared!    But, we did lose some coders.  Almost every practice I speak with, and I speak with a lot of them, has openings for coders.  This means that there are good, interesting jobs out there.   Tell your friends, share you “retired” coding books and old coding magazines with them.  Start recruiting your future co-workers!  There is a need.

And by the way, I haven’t run out of things to fear.  As mentioned above, we have a whole new set of acronyms with complex rules behind them (MIPS, QPP, VBM, APM, MACRA to list a few).  The education portion of our carriers is never-ending, thankfully! 

Rebecca Caux-Harry, CPC, is the CodeRyte product specialist for cardiology with 3M Health Information Systems.