The October 1st deadline for ICD-10 implementation has come and gone, and hopefully you have weathered the transition with only minor disruptions. If you are like most provider organizations, you have been preparing for the switch for months and embraced the switch with cautious optimism. But now that you are fully committed to ICD-10, it’s time to evaluate how deeply the new system has impacted your core objectives. Here are three indicators to focus on, measuring your current performance against your past performance.
As you well know, ICD-10 is both significantly larger and a lot more complex than ICD-9. That led many to worry that the new system would degrade productivity. When Canada switched over to a version of ICD-10, provider networks across the country experienced huge productivity losses, but the scope of that transition was also far larger. Compare your output now with your output at the same time last year. If you observe significant declines, you can likely reverse the trend by investing more in ICD-10 training and making clinical documentation improvement a priority. Finding innovative ways to root out inefficiencies and encourage automation are also solutions.
In advance of the ICD-10 rollout, the American Medical Association issued the dire prediction that denial of claims could reach rates as high as 20 percent. That figure is likely exaggerated, but there is no way to know until you start doing some comparisons. Again, calculate denial rates now and compare them to the rates from the same time last year and in years previous. Here are some specific areas to focus on:
- The number of days spent in accounts receivable
- The overall rate of denials
- The total amount of reimbursements that have been denied
- The match between reimbursements and contracted rates
If the research reveals that denials are on the rise, denial management needs to become a priority. Ongoing tracking is the first step. Monitor denial rates on a weekly basis to help spot small problems before they become catastrophes.
Physician’s understanding of ICD-10 likely pales in comparison to your coding staff. That forces your staff to make queries which eat up a lot of time and productivity. If this has already proved to be a problem, there are several steps you can take to make the query process more efficient. Write in clear, concise language that incorporates ICD-10 terminology, avoid asking leading questions, use specific evidence, and include the query in the clinical documentation. Taking these steps improves the quality of the information delivered in return and helps to educate physicians on the essential features of ICD-10.
How is your team doing? If you feel that things could be improved by working with a consultant or bringing in new talent, contact MedPartners.