The Problems & Challenges

• Under documentation for ICD-9
• Under trained physicians
• Scope of the problems are usually unknown

Most entities don’t really know the extent of their problems and opportunities.

How well do your physicians document?

How accurate and defensible is your coding?

How thorough are your submissions?

• Approximately 80% of all submitted RA/HCC codes come from PCPs.
• On average, 90% of records reviewed from PCPs offices have errors.
• There is not a data system that can determine which one-out-of-ten charts NOT to review.
• Physicians have not, for the most part, ever been reimbursed for accurate ICD-9 codes.  They’ve been reimbursed for CPT codes that don’t require an accurate ICD-9.
• ICD-9 requires specific documentation to defensibly support assignment.
• Physicians don’t understand the specifics of RA/HCC
• Physicians' documentation is generally inadequate to support accurate assignment of Risk Adjusted ICD-9 codes.
• Physicians have had minimal training and most have had minimal follow-up/on-going training.
• ICD-10 requires even more specific documentation than ICD-9.
• There will be a sizeable impact of ICD-10 if we are not ready.  Job one is to focus on more specific documentation for ICD-9.  After that, ICD-10 will be easy.

MARSI can help.