Healthcare has a large number of coders fixing claims just before they go out the door. Very often, it is the same types of edits that are being fixed on a daily basis. This is time-consuming and labor intensive. It also increases days in A/R. Yet it is status quo for many in healthcare.
The status quo will not be sufficient – at all - when ICD-10 codes arrive. There will be more errors, more time spent fixing claims, more days in A/R, etc. To maintain productivity, most healthcare organizations will need to hire more coders. However, coders are in high demand as it is. Furthermore, many experienced coders will be retiring before the ICD-10 deadline in 2013. I was at a regional AHIMA meeting where coders were asked, “How many of you are planning to retire before 2013?” 25% of the coders raised their hand!
The situation calls for more than incremental improvement. The whole claims process needs to be assessed. I believe the best way to do this is to think about it as a classic quality management process. Claims are healthcare’s widgets. From its beginning in Japan, the quality process has become imbedded in almost every industry across the globe. It includes sampling, root cause analysis to pinpoint the source of errors, and education to reduce the incidence. Many healthcare organizations are improving the quality of care, but we also need to apply these concepts to claims.
Some leading healthcare organizations have done this. For example, Kaiser Permanente, Denver, moved the “claims correction” process to the front end, where the claim was being coded. That way, the claims were correct at the beginning. Accurate coding never needs a refund. Nor does it put your organization at risk. At Kaiser, it reduced the workload for coders, so that they could focus on education. It’s the only way to prevent the error in the first place. And physician education regarding coding and documentation has never been as important as it is now, with the impending ICD-10 deadline.
Redesign your process so that you get clean claims out the door now. Educate your physicians on the ICD-10 codes they will need to know (not the ones they won’t) now. It will behoove you to have this knowledge and these processes in place before October 2013. There will be lots more to worry about then, like cash flow. We'll talk in the next blog about the queuing effect, as the process slows down for ICD-10 coding.
Robert Freedman is a healthcare auditing solutions executive at Hayes Management Consulting. He works with healthcare organizations to reduce billing compliance risk.