We are now six months into the implementation of ICD-10 and without industry-wide metrics to evaluate our transition. Independent surveys report productivity reductions ranging anywhere from 30-45 percent on the inpatient side and an outpatient reduction of 20-40 percent. These numbers are significant and likely to lead to a disruption in the revenue cycle.
With industry-wide data unavailable, the responsibility of tracking ICD-10’s impact is left to healthcare providers. So how do you go about doing this? The Centers for Medicare and Medicaid Services’ published document, ICD-10: Next Steps for Providers Assessment and Maintenance Tool Kit, recommends facilities monitor progress through the use of Key Performance Indicators. The article lists numerous indicators including: Days to Final Bill; Claims Rejection and Denial Rates; Coder Productivity; Query Volumes; Unspecified Code Usage; and Incomplete/Missing Charges. Not all indicators apply to all facilities, so choose based on the needs of your organization. The analysis of subsequent findings provides an avenue to identify and address issues of productivity, reimbursement and claim submission.
A successful monitoring process does not end with discovery though. Be certain to utilize your findings in a manner that provides additional value above and beyond ICD-10. Implement a systematic approach for staff involvement, clinical documentation, coding improvements and most importantly education. One way to do this is to develop an inclusive education and outreach program. Be certain educational resources are distributed in a timely manner and employ a physician champion. Physician champions are key to successful education programs, as they facilitate communication between health information management, physicians and clinical documentation improvement staff. Training physicians provides the best opportunity for the capture of clinical information resulting in correct coding, reduced queries and ultimately, timely clean claims.
What are the results of your ICD-10 transition? How are you monitoring your facility’s progress? We’d love to hear from you.