by Laurie M. Johnson, MS, RHIA, FAHIMA, Senior Consultant, Revenue Cycle Solutions, LLC
It’s hard to believe that we are already well into FY2022. While the changes to the codes and guidelines have been in effect for a while, if you haven’t completed all of your fall clean-up tasks, you should begin as soon as possible:
#1. Identify New Technology
The Centers for Medicare and Medicaid Services (CMS) provides additional payment for using new technology items. New technology items are defined as new, high-cost technology that significantly improves patient outcomes. The cost of these items is not covered by the MS-DRG payment, so CMS provides additional payment based on the appropriate ICD-10-PCS code. There are 42 items for FY22. (Unfortunately, CMS does not release an easy list but the new technology items are included in the IPPS Final Rule for FY22.) It is not too late to identify these items and correct the claim with the appropriate ICD-10-PCS code. You can’t afford to leave the dollars on the table.
#2. Update Facility-Specific Coding Guidelines
Your facility-specific coding guidelines are the road map for the coding staff to code consistently. If you do not have facility-specific coding guidelines, the American Health Information Management Association (AHIMA) has a practice brief for developing facility-specific coding guidelines.
#3. Research Social Determinants of Health
SDoH, covered with code range Z55 – Z65, is a very hot topic currently. Your facility may have an interest in social determinants of health (SDoH), but may not have the data to support their activities. The Official Coding and Reporting Guidelines for ICD-10-CM for 2022 were updated to include the ability to use documentation by other clinicians to capture SDoH data. It is important to discuss with leadership and managers at your facility their interest or payers’ interest in SDoH. The discussion should include which documentation to be used to capture this data. When the topic is developed, your facility-specific coding guidelines can be updated to include this information.
#4. Identifying Potential Denials Pre-Bill
Review the history of coding/clinical validation denials and identify the diagnoses that are risky. Develop a process to stop these claims prior to dropping the claim so that they can be addressed pre-bill. Another step is to determine what can be done to reduce these types of denials. The answer may be additional queries or provider education on specific topics. These denials are on the increase, so it is best to develop your response process now.
It is important that your organization address these concerns before the fiscal year progresses further. It may call for an all-hands-on-deck effort. If you have a Revenue Cycle Committee, they may be able to assist in your fact-finding. Happy Cleaning!
Laurie M. Johnson, MS, RHIA, FAHIMA
Laurie M. Johnson is a senior consultant at Revenue Cycle Solutions, LLC, a revenue cycle consulting firm specializing in revenue cycle assessments and work plan implementation; interim management with focus on process improvement; and revenue cycle education for hospitals and physician practices. Laurie is a past president of PHIMA and author of clinical coding articles for Journal of AHIMA and ICD-10 Monitor.
FY 2022 Code Updates: ICD-10-CM, ICD-10-PCS, and CPT
FY 2022 Code Updates: Learn what the changes mean and how to apply them. Purchase individually or pick your bundle and SAVE! Train your entire team and save even more!
Contact [email protected] for group pricing.
Bonus! Receive a full year of Coding Clinic Commentary, a $100 value FREE with your purchase of two or more Code Updates.