Have A Small Medicare Footprint? Think You Don't Need To Worry About ICD 10 Coding? Think Again!
After years of being in the business of homecare consulting, we have seen importance of accurate ICD 10 coding increase. However, those who primarily focus on Medicaid services in their area tend to dismiss the importance of the ICD 10 code. We consistently see these agencies doing coding internally by non-certified coders. Sometimes it's nurses who did the admission or better yet, another staff member such as an office manager who does the codes when needed. Let's talk about why this hurts your from a compliance level and big time when it comes to your financials.
But We Only Do A Small Amount Of Medicare:
Here's the thing: The method of your ICD 10 coding should not be determined by the size of your Medicare footprint. That's right. Whether you do in-house or outsourced ICD 10 coding is a matter of clinical accuracy, compliance and proper reimbursement. Let's look at each one of those items and why have the proper ICD 10 code is so important.
- Proper Reimbursement: In our experience, most small Medicare agencies complete in-house coding and it is done by someone with more than one role in the organization. The reality is that when people function in multiple roles within your organization, the individual gravitates to the role he or she most enjoys. In cases where your coder does multiple roles, how many will say coding is what they enjoy the most? Therefore, ICD 10 coding is normally a small task with not much time spent on accuracy. When we see non-certified coders completing this task, it is not uncommon for us to see errors from as small as $100 per episode up to $1,000 per episode missed in potential reimbursement. If you only do 2 Medicare admission per month, then you have lost up to $24,000 of reimbursement with poor coding. While it is understood that small Medicare agencies may not want to invest in the cost of an in-house employee for a small number of codes, it makes sense to outsource the task and get it right.
- Clinical Accuracy: Whoever completes your coding needs to understand the documentation provided both by the nurses within the assessments but also from outside sources. The individual must understand the Oasis tool and how it fits together to determine the complexity of the patient. The coder must understand what specificities must be present in the coding not only for reimbursement purposes, but also to help guide the care plan.
- Compliance: This one encompasses everything. You have to make sure the person in charge of your coding isn't doing it improperly. The industry has dealt with case mix creep over the years because CMS thinks this is what happens. If your coder is going to use a specific code, then there must be evidence in the chart to support use of the diagnosis that has more reimbursement attached. We have been asked to evaluate operations in struggling agencies and have seen this happen. The non-certified coder picks the code that will provide the agency more reimbursement without the documentation to back it up. Your agency get set up for takebacks, ADRs, and potential non-scheduled surveys. We also see agencies where the coder tends to stick with the same few codes and you miss out on a ton of reimbursement routinely because the time and attention is not put into coding.
Ultimately, ICD 10 coding is so important and not to be dismissed regardless the size of your Medicare footprint. What do you potentially lose both on the clinical and financial side with bad coding? If you have a small Medicare footprint, just make the call and outsource your Medicare coding. It isn't worth the loss of money or risk of non-compliance. If you aren't sure about your agency's coding grade card, call Kenyon Homecare Consulting at 206-721-5091 or contact us online . We will complete 5 free recodes to see if your ICD 10 coding is on point or if it misses the mark!
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