ICD-10 Audit Readiness: 5 Facts About Conducting Internal Audits for ICD-10

Implemented last October, ICD-10’s overhaul to the diagnostic code set was pushed back several times in anticipation of what effect such a change would have on U.S. healthcare systems. Providers have put their coding staff through rigorous training programs in an attempt to minimize the impact of the shift, but now that the implementation period is over, they must make sure their coders stay on target, with potential ICD-10 audits by CMS on the horizon. Are you really prepared for what this year will bring? Here are 5 benefits to conducting internal audits to consider.

  1. A robust governance framework is the only way to account for all the changes in ICD-10 simultaneously.

ICD-10 has 5 times as many diagnosis codes and 19 times as many procedure codes as ICD-9, its predecessor. In order to manage this new level of specialization, having internal frameworks for keeping track of implementation and conducting audits within your organization is the only way to make sure you start off ICD-10 on a solid footing.

  1. Learning from previous implementations of ICD-10 is the best way to avoid blunders. Understanding the unique challenges that arise in the first year of ICD-10 implementation is the way to head assessment issues off at the pass. The U.S. is actually implementing ICD-10 long after many other developed countries have implemented it, and this gives us the advantage of hard data on what problems show up in implementation for the first few years. We have an ideal perspective to be able to tackle the unique issues of ICD-10, we just need to tap into that knowledge and apply it via comparison with the experiences U.S. facilities are having.
  1. Self-assessments are absolutely essential, otherwise you’ll have no idea what’s going on. All the preparation U.S. facilities went through to account for the new codes cannot protect them from simple errors, and oversight is meaningless without quantitative data. Revenue is protected when proper coding is verified after the fact, ensuring that mistakes made are not mistakes repeated, and that coders don’t get trapped in habits of error. An understanding of how audits work structurally is the only way to prepare for external audits, and the best way to develop that understanding is to conduct audits internally.

4. Remediation activities will be easier to implement coming off an internal ICD-10 audit than an external one.

Having plans—the more the better—to handle possible scenarios that could arise during an audit is extremely useful, and particularly so if you have ways of fixing problems as they arise that are prepared before the problems actually become evident in other ways, such as lost revenue/decelerated payments.

  1. Internal audit results have bigger and better uses than simply preparing for external audits/preventing them.

For one thing, they can be used to make revenue more efficient. For another, you can use the results of the audits for branding and marketing purposes and as a demonstration of how quality is ingrained in your culture. Good internal audit results can result in fewer external reviews, as well.

This presentation by internal audit and compliance expert, Susan Ulrey, on Tuesday, Jan 19, 2016, will help you understand how the ICD-10 audit process works, and discover and correct potential issues before they become full-blow problems.

Leave a Reply

Your email address will not be published. Required fields are marked *