By Lisa A. Eramo
ICD-10, device-generated data, value-based payments, and EHR compliance were just a few of the timely topics discussed during HEALTHCON 2016—the 24th annual conference sponsored by the American Academy of Professional Coders (AAPC). Nearly 2,700 billing and coding professionals attended the event that took place in Orlando earlier this month.
This year’s event drew attendees to a wide variety of sessions, reflecting a larger trend toward expansion of coder skillsets into various aspects of practice management.
During an inspirational general session, Stephanie Cecchini, CHISP, CPC, CEMC, encouraged attendees to take advantage of industry changes by climbing the career ladder to a six-figure income. In particular, she urged coders to follow their passions, commit to lifelong learning and networking, and constantly sell the importance of medical coding to others in the healthcare profession—particularly physicians.
Similarly, other speakers empowered coders to strengthen compliance and mitigate risk for the practices in which they work.
During a presentation about denial management, Yvonne Dailey, CPC, CPB, CPC-I, told coders that 90%-93% of claims rejections are preventable. She encouraged coding and billing staff to “learn the lingo” of denials to ensure that they have carrier-specific edits in place. She also encouraged attendees to track denials, analyze the root cause, and develop corrective action plans.
In addition, Dailey reiterated the importance of a financial policy that clearly explains patient financial responsibility in the event of non-coverage. She reminded attendees that claim submission is a technically a courtesy that practices extend to patients. “Get patients involved ASAP if claims aren’t being paid,” she added.
During a session on policies and procedures, Dailey reminded coders to remain vigilent in terms of denial management and develop policies and procedures that continually evolve as new transmittals and rules are published. “Appoint someone to monitor [this information],” she said. “Don’t wait until you find out on the revenue side that there’s a problem.”
Compliance was also a theme during a session about billing for transitional care management (TCM) and chronic care management (CCM). Speaker Stephen Canon, MD, reminded coders of specific requirements for TCM and CCM and provided strategies for overcoming reporting barriers associated with discharge notifications, scheduling follow-up visits, and meeting all documentation requirements.
ICD-10 compliance was a topic of discussion as well. Vince Kobayashi said unspecified codes continue to challenge coders, although many practices have yet to see an influx of denials. “The problem is documentation. It’s the ‘data in,’” he said.
As the industry continues to progress with ICD-10, Ann Bina, COC, CPC, CPC-I, reminded coders to focus not only on productivity but also quality. During this interactive session, many attendees stated they kept their quality standard at 95% despite the transition to ICD-10. One attendee stated that her quality standard remained at 98%.
In addition to coding and billing compliance, various sessions touched on challenges associated with EHRs. During a panel discussion featuring six healthcare attorneys, several questions pertained to EHRs directly:
- How should practices generally handle auto-population in the EHR? Michael D. Miscoe, Esq., CPC, CASCC, CUC, CCPC, CPCO, CPMA, CHCC, said auto-population affects the credibility of the work performed and that practices definitely shouldn’t pull information forward simply to drive an E/M score.
- Should practices copy and paste all lab results received during the last six months? Timothy P. Blanchard, JD, MHA, FHFMA, urged attendees to consider whether the labs are truly relevant to the current visit or whether this information will simply add to the volume of data in the record without adding any clinical insight.
- Will auditors begin to ask for an EHR audit trail? Several panels stated that some Medicaid contractors and commercial payers are already asking for this information. They encouraged attendees to work with their EMR vendor to ensure that it can provide this information when requested.
Angela Jordan, CPC, spoke about challenges associated with EHR templates and encouraged coders to serve as front-line support to catch errors related to speech recognition and to validate appropriate diagnosis and service codes, add-on codes, and modifiers.
In looking ahead, speakers touched on new technologies and shifting reimbursement models.
For example, Scott Klososky urged coders to embrace the effects of technology—particularly mobile technology and wearables—on healthcare. “Wearable data will improve preventive medicine,” he said. “The more data that spins off our mobile devices, the more addicted we’ll become to these data streams.”
As EHRs continue to evolve into continual live databases, he urged attendees to consider the following questions:
- How must privacy and security models evolve?
- How might having access to deeper health histories and real-time data affect clinical decisions and workflow?
- How might mobile/real-time data affect the business side of healthcare? For example, Klososky said subscription-based healthcare plans may offer additional revenue streams for physicians. With these plans, physicians would monitor device-generated data and provide proactive and personalized interventions in exchange for a fee.
Dan Schwebach, MHA, CPPM, said “data, frankly, is becoming the new currency.” He encouraged coders to look ahead at how healthcare will likely evolve over the next two decades to include population health management, greater use of telemedicine and remote monitoring, pricing transparency, consolidation, and competition based on value. As value-based healthcare continues to mature, he reminded attendees that coded data drives risk adjustment as well as outcomes and quality data.
About the Author
Lisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.