The new federal fiscal year (FY) begins on Oct. 1, this coming Sunday. In preparation, I thought that I would review my top 10 activities for providers to prepare. Here we go…
- Review new ICD-10-CM/PCS codes with coders, who should be aware of the changes. Schedule a coding audit to validate coding accuracy of the coding staff. The Hierarchical Condition Categories (HCCs) are being updated as well. Take the time to make staff aware of the changes and available resources.
- Update/create facility-specific coding guidelines:
- Identify New Technology Add-On Payment (NTAP) items that are utilized by your facility, as well as documentation that supports the ICD-10-PCS code(s).
- Maintain a copy of the previous version to be utilized with any performed audits for the 2023 fiscal year.
- Identify inpatient procedures to be coded.
- Address the social determinants of health (SDoH). Remember that homelessness is now a comorbid condition. Also, specify the source document for SDoH.
- Remember that the pandemic is over. The coding rules for COVID have changed:
- Screening for COVID-19 should be coded as Z11.52 for non-symptomatic patients (e.g., pre-operative).
- Only patients with actual exposure to COVID-19 are now coded as Z20.822 (Exposure to COVID).
- With the release of a new COVID booster shot, most patients will be now partially vaccinated (Z28.311).
- Review MS-DRG changes with inpatient coders. There were major changes in the Circulatory System Major Diagnostic Category (MDC), so they should be prepared.
- Remember that prospective payment methodology changes go into effect for Inpatient Psychiatric Facilities (IPFs), Skilled Nursing Facilities (SNFs), and Inpatient Rehabilitative Facilities (IRFs) on Oct. 1. If your facility has any of these licensed special units, you will have to review the changes.
- Review the changes to the ICD-10-CM/PCS guidelines. The definition of “reportable diagnosis” was updated to include clinically significant factors. Discuss and document how your facility will interpret this change.
- Set measurable departmental and/or personal goals for the year. Review the key performance indicator (KPI) results for your department with the staff. This review will assist in setting new departmental goals. Having goals is a good method of providing direction for the department/team/yourself.
- Become active in the denial process. Reading the denial letters is very educational. These letters provide another viewpoint to coding, as well as clinical focus for clinical validation denials.
- Complete provider education. Perform a retrospective review of queries. What were the identified issues by clinical service? My recommendation would be to give small discussions on documentation improvement.
- Celebrate with the team. Let them know that their work and improvements are appreciated.
A new fiscal year provides time to review the past year’s achievements and plan for the upcoming year.
Here’s to FY 2024!