ICD-10 has been in use for almost 6 months. Now is a good time to take a critical look at how you and/or your organization has fared during the transition, and to pinpoint where you may still have issues with:
- Cash Flow
This is also a good time to identify opportunities for:
- Additional training
- Documentation assistance
- Operational changes
The first step in analyzing how your organization is doing is examining key performance indicators.There are 2 categories to look at: coding related indicators and billing related indicators.
Coding Key Performance Indicators:
When you’re examining your coding performance under ICD-10 be sure to look at:
- Code frequency
- Coder productivity
- Volume of coder and/or provider questions
- Use of unspecified codes
- Physician or non-physician practitioner productivity
- Clinical documentation versus ICD-10-CM code selection
- Increase or decrease in number of queries
Billing Key Performance Indicators:
When you’re examining how your billing has fared under ICD-10, look at:
- Claims denial rate
- Payment amounts by payer
- Medical necessity pass rate
- Discharged not final billed (for hospital inpatient services)
- DRG volumes by group (ICD-9 versus ICD-10, for hospital inpatient services)
- Clearinghouse edits
- Payer edits
- System issues
Pre-implementation data from coding and billing will provide a good baseline to measure the impact the ICD-10 transition has had on your organization. Analysis should be performed periodically on the most recent data to identify trends over time.
Once you’ve completed your analysis, don’t forget to communicate the results of your assessment to key stakeholders in your organization. These stakeholders include physicians as well as administration team members as can provide valuable feedback to help you identify problems as well as possible solutions.
For more information on how you can assess ICD-10 at your organization, check out this article on ICD10monitor.com. Hopefully this information is helpful as you assess where you are with the ICD-10 transition and how to make necessary changes.
Hopefully this information is helpful as you assess where you are with the ICD-10 transition and how to make necessary changes.