The Top 4 Coding Predictions You Need to Know in 2016

Well, folks, it’s probably safe to say that the transition to ICD-10 was a lot of bark and only a little bite. Roughly four months after the October 1 implementation deadline, most clinics are doing fine—but that doesn’t mean you’re done worrying about the coding change’s effect on your practice. In fact, 2016 brings with it several new coding challenges, both big and small. To help you prepare, we’ve put together a list of our top four coding predictions for the new year:

  1. According to the ICD-10 Monitor, 2016 will bring on more coding assessments, reviews, and audits. At this point, you’ve processed enough claims to start evaluating—and, hopefully, validating—your ICD-10 processes. If you uncover weaknesses, you’ll need to adjust your current best practices and metrics tracking processes—or establish new ones. What used to be “business as usual” for your clinic during the reign of ICD-9 may not be possible in the ICD-10 world. Not sure how to perform an ICD-10 assessment? Check out this how-to article from ICD-10 Monitor.
  1. Thanks to the above audit forecast, the experts at H.I.M. ON CALL, a health information and coding solutions company, believe we may experience nationwide auditor shortages. So, if you need to hire one, do so as soon as possible. You may even need to upgrade your technology to manage all those audits in a timely manner. Furthermore, these experts predict those audits will reveal accuracy rates 32% lower than pre-switch rates. If you find yourself facing a large drop in claims accuracy, it’s time to hit the books for a refresher course on ICD-10.
  1. Expect a comprehensive code update when the coding freeze thaws this fall. To help ensure a successful implementation, the US has held off on adding any new ICD-10-CM (and PCS) codes for the past four years. But that all changes on October 1, 2016—exactly one year after the mandatory transition to ICD-10. This update likely will be massive, so you should prepare for it in the same way you prepared for the transition itself. CMS may release more information as we get closer to update time, but for now, just know that you should expect new subcategories and tons of indexing changes.
  1. Big data isn’t just for big clinics. Thanks to ICD-10’s increased specificity, we have more—and better—data than ever before, and as this coding expert explains, we can “expect to see requests for detailed data increasingly utilized in smaller organizations.” We believe the push for data is a good thing, but it also can place a burden on coders who already have full plates—especially at smaller clinics where everyone wears multiple hats. So, make sure you provide your staff with the software training they need to meet new data demands.

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Like a high school graduate taking a gap year before entering college, the one year grace period from CMS allows you time to get a firm grip on ICD-10 and optimize your processes. But we’re already more than a quarter of the way through it, so there’s no time to waste. With these coding predictions in mind, you can start facing these coding challenges head-on—and make 2016 your best year yet.