BC Advantage - 2016 Issue 6
Post ICD-10: What Physician Offices Need to Consider
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Article Overview
This article discusses how physician practices can use the ICD-10 transition window to strengthen documentation, review medical necessity, monitor payer denials, and prepare for post-transition scrutiny. It is aimed at office managers, coders, billers, and clinical staff who support physician documentation and reimbursement workflows. The piece also addresses broader oversight concerns involving Medicare contractors and related compliance review activity.
Why This Topic Matters
The article matters because it highlights practical areas that can affect claim acceptance, denial trends, and audit exposure in physician settings after ICD-10 implementation. It helps readers understand the kinds of operational and compliance issues that deserve review before routine payer and contractor oversight intensifies.
Article Sections
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Medical Necessity
Discusses documentation and coverage considerations for office-based testing and procedures during the transition period. It focuses on the importance of reviewing payer coverage expectations and supporting the service with appropriate records.
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Assessing Documentation
Covers ways to evaluate whether provider documentation captures the level of specificity needed in different specialties. It also addresses internal review, workflow support, and communication with providers and systems staff.
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Evaluate Every Denial
Describes the value of tracking denied claims and reviewing them for patterns over time. The section emphasizes denial monitoring, appeal awareness, and preventing repeat issues.
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RACs, MACs, and the Rest of the Alphabet Soup
Summarizes the roles of major Medicare oversight entities and the kinds of claim comparisons and review activity that may occur. It also notes how inpatient and post-acute payment issues can affect multiple parties.
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Conclusion
Wraps up the article’s emphasis on operational preparation and documentation improvement during the transition window. It reinforces the broader need for workflow readiness after the implementation period.
What You Will Learn
- How physician offices can use a transition period to review documentation practices
- Why medical necessity review is important for office-based testing and procedures
- How to assess whether providers are capturing enough clinical specificity
- How to monitor denials for trends and potential appeals
- What oversight entities may be involved in post-transition review activity
Who Should Read This
- Physician practices
- Office managers
- Medical coders
- Medical billers
- Clinical documentation staff
- Compliance staff
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