In a session at the 11th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference in Chicago on June 14, Tim Meakem, MD, medical director at ProVation Medical, discussed the increased importance of proper documentation and coding by physicians and what it means for the practices and ambulatory surgery centers where they treat patients.
When Dr. Meakem was in medical school, he said, there was no discussion on the business side of healthcare; everything was about making the patient better. Today, he said, that approach can be dangerous. The increased scrutiny by regulators on documentation and coding means physicians must understanding coding issues to ensure compliance.
ICD-10
The conversion from the ICD-9 coding system to ICD-10 will present a challenge to physicians because of the increased number of codes they'll be required to use.
"The orthopedic section is expanding more than any other area of medicine," he said. For example, the number of codes for a fracture of the radius will expand from 1 to 16 codes, and spinal stenosis codes will expand from 1 to 30.
Failure to provide the required specificity under ICD-10 can be a liability because you must have clinical document corresponding to the specificity of new codes, he added.
RACs
Medicare recovery audit contractors are also a concern for providers. RACs currently review claims after they are paid and request repayment of any payments that lacked necessary documentation. In addition, RACs recently began a demonstration project for pre-payment audits in which they review claims submitted on select DRGs before they are paid to ensure the provider complied with all Medicare rules.
MACs
State Medicare administrative contractors also have begun pre-payment audits to ensure compliant claims. Dr. Meakem shared the results of a single state's pre-payment review program. In the program he highlighted, 60 percent of examined claims for MS-DRG 460 (spinal fusion except cervical without MCC) were not paid because of errors in the claims.
How do you handle these challenges?
Dr. Meakem encouraged providers to leverage automation and technology to improve complete coding, and ultimately, coding compliance. "Use technology to match up the diagnosis with the code," he said. Medical documentation technology provides three key benefits to physicians.
When Dr. Meakem was in medical school, he said, there was no discussion on the business side of healthcare; everything was about making the patient better. Today, he said, that approach can be dangerous. The increased scrutiny by regulators on documentation and coding means physicians must understanding coding issues to ensure compliance.
ICD-10
The conversion from the ICD-9 coding system to ICD-10 will present a challenge to physicians because of the increased number of codes they'll be required to use.
"The orthopedic section is expanding more than any other area of medicine," he said. For example, the number of codes for a fracture of the radius will expand from 1 to 16 codes, and spinal stenosis codes will expand from 1 to 30.
Failure to provide the required specificity under ICD-10 can be a liability because you must have clinical document corresponding to the specificity of new codes, he added.
RACs
Medicare recovery audit contractors are also a concern for providers. RACs currently review claims after they are paid and request repayment of any payments that lacked necessary documentation. In addition, RACs recently began a demonstration project for pre-payment audits in which they review claims submitted on select DRGs before they are paid to ensure the provider complied with all Medicare rules.
MACs
State Medicare administrative contractors also have begun pre-payment audits to ensure compliant claims. Dr. Meakem shared the results of a single state's pre-payment review program. In the program he highlighted, 60 percent of examined claims for MS-DRG 460 (spinal fusion except cervical without MCC) were not paid because of errors in the claims.
How do you handle these challenges?
Dr. Meakem encouraged providers to leverage automation and technology to improve complete coding, and ultimately, coding compliance. "Use technology to match up the diagnosis with the code," he said. Medical documentation technology provides three key benefits to physicians.
- Ensure medical findings specifically correspond to the codes that are submitted
- Help establish medical necessity and support (and defend) against any challenges to codes submitted
- Ensures documentation is complete and coder-ready. This saves coders from digging for additional information sometimes long after the physician has treated the patient, which is inefficient and can contribute to inaccuracies.