Coding Changes Require New Staff Skillset

Six months after ICD-10 began, home health agencies are already looking down the barrel of a few thousand changes set to go into effect October 1, 2016. Since the implementation of the new coding system, home health agencies and other health care providers have learned a lot, and with more changes coming, it’s crucial for executives to know how to improve productivity and accuracy.

“Way back when, when ICD-10 was on the horizon and looming, much of the industry felt like it could have been a catastrophic event, a Y2K feeling,” Tim Ashe, RN, MSN, partner at home care and hospice consultant firm Fazzi Associates, said during a webinar on ICD-10.

However, those fears largely didn’t come to pass as the new coding changes went into place at the start of 2016.

While most home health agencies were well-prepared for ICD-10 and met their new requirements head on without disruption, adding thousands of new codes has had some effect, according to Fazzi Associates.

“With the massive coding changes comes a learning curve,” Ashe said. “We are seeing a decline in productivity. The ability to produce accurate, reliable data through OASIS and ICD-10 is critically important.”

With increased scrutiny on home health for fraudulent and improper billing from the Centers for Medicare & Medicaid Services (CMS), home health care companies are finding that caregivers need skills outside the clinical side of the business. For instance, a caregiver that is able to document quickly and accurately, as well as learn new software, may be a more valuable employee in the coding environment today.

“[There is a] need for ongoing staff training, an emphasis placed on training for all home caregivers to be accurate and to continue to improve quality,” Termine said. “The shifts we are seeing in the field for skills beyond clinical understanding are becoming more prevalent.”

In addition, CMS is rolling out its pre-claim demonstration in five states—the first begins in Illinois no earlier than August 1—and will put further pressure on agencies to submit their documents accurately and as timely as possible.

Compared to ICD-9, new coding requirements have a lower rate of accuracy in 2016 so far, according to Fazzi.

“Of the 4.6 million total claims submitted per day, 2% were rejected for incomplete or invalid coding,” Kerry said.

Here are the most common ICD-10 errors related to coding, according to Fazzi:

-Not coding the most specific diagnosis supported in the record

-Overutilization of therapy codes/symptoms codes that are integral to other diagnoses and do not need to be coded separately

-Lack of physician specification in documentation

Written by Amy Baxter