ICD-10 Compliance: Process Improvement and Maintenance for Long-Term Car

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ICD-10 Compliance: Process Improvement and Maintenance for Long-Term Care

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ICD-10 Compliance: Process Improvement and Maintenance for Long-Term Care

Maureen McCarthy, BS, RN, RAC-MT
Kristin Breese, BSN, BSed, RN, RAC-MT

Is your long-term care facility prepared to implement ICD-10 coding? Between the additional specificity required for code selection and the substantial increase in the number of codes, developing efficient processes is imperative to managing the increased workload.

Train your staff now to ensure that effective and compliant processes are in place with ICD-10 Compliance: Process Improvement and Maintenance for Long-Term Care. This book focuses on process improvement before and after the October 1 implementation date. It highlights areas facilities can improve, including collaborating with physicians on documentation accuracy, working with vendors, analyzing revenue risks, claim reviews, and audits. It will help facilities continually monitor their processes to ensure everything is running smoothly.

This resource provides:

  • Various examples of effective processes that SNFs can integrate, including specific rationale behind each option
  • Explanations on what could potentially prevent payments
  • Guidance on how to ensure physician documentation accommodates ICD-10 coding
  • Education on how to code new encounters
  • Dual-coding examples
  • Direction on how to untangle vendor issues to protect SNF Medicare dollars


Table of Contents:

  • Chapter 1: Introduction to ICD 
    • Why ICD-10?
    • Benefits of Implementing the ICD-10 Coding System
  • Chapter 2: Planning the Transition to ICD-10
    • How to Get Started
    • Critical Tasks
    • Coding Impact
    • How Would an Organization Finish the Transition if They Started?
  • Chapter 3: Determining the Impact on Operations
    • Determine Implementation Impact—Internal vs External
    • Establishing a Transition Plan
  • Chapter 4: Budgeting for the ICD-10 Transition
    • Budgetary Impact—Implementation Costs
    • Predictive Budgeting
  • Chapter 5: Organizational Implementation/Transition Phase
    • Training the Facility Coding Staff
    • Preparing the SNF Physician for the Transition
    • Value of Adoption of ICD-10-CM
    • Assigning ICD-10 Codes
    • Discharge Summary Examples
    • Testing Phase
  • Chapter 6: Claims Processing and Auditing
    • Role of the MAC in Claims Edits and Education
    • General Claims Submissions and Edit Information for All MACs
    • Auditing for Valid Appropriate ICD-10 Codes
    • Free or Low-Cost Resources
  • Chapter 7: Auditing and Tracking Tools
    • Auditing Claims for Errors
    • Triple-Check Policy & Procedure
  • Chapter 8: How SNF Diagnosis Coding Differs From Other Healthcare Settings
  • Chapter 9: How to Use the ICD-10 Manual
    • Episode of Care
    • Additional Guidance in Coding Fractures
    • How to Use the GEM Files
  • Chapter 10: ICD-10-CM Official Guidelines for Coding and Reporting FY 2015
  • Chapter 11: Diagnosis Code Set General Equivalence Mappings
    • ICD-10-CM to ICD-9-CM and ICD-9-CM to ICD-10-CM, 2014 Version, Documentation and User's Guide
    • Section 1—Mapping and the GEMs
    • Section 2—How to Use GEM Files
    • Glossary
    • Diagnosis Code Set, General Equivalence Mappings, 2014 Version
    • Documentation, Appendix A—File and Format Detail
  • Chapter 12: General Equivalence Mappings
    • Documentation for Technical Users
    • General Equivalence Mappings
    • ICD-10 GEMs FY2015 Version Update
    • DIAGNOSIS GEMs
  • Chapter 13: ICD-10 GEMs FY2015 Version Update
  • References


Who should read this book?

  • Administrators 
  • DONs 
  • Assistant DONs 
  • Nurses 
  • Staff educators 
  • Clinical managers 
  • Directors 
  • Nurse managers 
  • Coders 
  • Billers 
  • MDS Coordinators


About the Authors:

Maureen McCarthy, BS, RN, RAC-MT

Maureen is the President of Celtic Consulting, LLC and the CEO and founder of Care Transitions, LLP; a care coordination service provider. McCarthy is also the creator of the McCarthy Method, a documentation improvement system for ADL coding.

She has been a registered nurse nearly 30 years with experience as an MDS Coordinator, director of nursing, rehab director and a Medicare specialist. She is a recognized leader and expert in clinical reimbursement in the skilled nursing facility environment.

Maureen is not only dually certified in the resident assessment process by nationally recognized organizations, she is also a Master Teacher. Additionally, McCarthy is one of nine OASIS Master Teachers nationwide.  She holds a degree in Business Management as well as a Nursing degree and served as an expert witness for a national legal firm. In September of 2011, she released her first co-authored publication, The Long Term Care Compliance Toolkit

Kristin Breese, BSN, BSed, RN, RAC-MT

Kristin Breese is the Director of Operations of Celtic Consulting, LLC, and has been with Celtic Consulting since 2010. 

Breese has over 30 years of experience in the healthcare industry, is a registered nurse in multiple states, and has Bachelor’s Degrees in Nursing and Science Education. Kristin has a background in acute-care, homecare (including Infusion Therapy) and in the Skilled Nursing Facility environment. Her experience also includes positions held as a Regional Medicare Specialist, Director of Nursing, Director of Clinical Reimbursement and MDS Coordinator. Breese is nationally certified in the resident assessment process, is a Master Teacher and is one of nine OASIS Master Trainers nationwide.


Published: May 2015

Page count: 318
Dimensions: 8.5x11
ISBN: 978-1-55645-478-3