As we quickly approach the current deadline for ICD-10 transition on Oct. 1, the potential setbacks from an unsuccessful transition come into clearer focus. Backlogs, denials and impacts on revenue threaten organizations unable to cope with the new 68,000 code script in ICD-10.

According to a recent RelayHealth survey, only 13 percent of hospitals are fully ready for the ICD-10 transition. However, gauging the potential and actual impact of transition before and after the deadline can help organizations make ongoing adjustments.

Given the potential for significant performance effects after the ICD-10 deadline, we asked Cindy Cain, Director – Consulting at McKesson Business Performance Services, to share how organizations can best prepare for pre- and post-transition measurement.

Understand current results and identify training opportunities

Cain believes organizations should review current denial reports and edits to determine if the same reports will be beneficial once ICD-10 codes are effective. In addition, organizations should:

  • Determine on-going training needs/requirements
  • Continue to test claims

"Close auditing of ICD-9 coding has revealed weaknesses that could show up in ICD-10 coding as well," Cain said. "Unless these weaknesses are addressed in training, they could persist and cause problems after the transition, which could also impact timely filing limits with the health systems."

By measuring performance before the deadline, you’re more likely to catch performance declines after the transition.

Establish a performance measuring process before the deadline

Cain feels that internal and/or external coding reviews can help organizations identify any provider who may require additional ICD-10 training.

"ICD-10-CM and -PCS offer greater detail and increased ability to accommodate new technologies and procedures," she said. "ICD-10 has the potential to provide better data for evaluating and improving the quality of patient care. Data captured by the code sets could be used in more meaningful ways to better understand complications and track care outcomes."

Focus on key performance items

Denial rates, AR days, claim error rates and DNFB rates are all critical items to track in any ICD-10 measurement process. Cain offers some rationale on why organizations should test these metrics as soon as possible:

  • Denial rates: Current ICD-9 denials should be reviewed to avoid similar ICD-10 denials or additional denials due to the specificity of ICD-10 codes.
  • AR days: Staff responsible for AR will have to work both ICD-9 and ICD-10 codes for a certain amount of time.
  • Claim error rates: On-going testing and working with clearinghouses and front-end scrubbers can help identify any ICD-10 errors.
  • DNFB rates: Lack of response or late response from ICD-10 complexity indicates a delay in billing, which directly impacts DNFB.

Where to start with your tracking

By tracking these key metrics, you can help set effective baselines for post-transition measurement and avoid costly process corrections.

"You have to start measuring something, such as charts coded in a day and coding accuracy," Cain said. Start with medical coding productivity, which can be measured by answering the following questions:

  • How long it takes a coder to correctly code a claim?
  • How fast does a claim get out the door to the payer?
  • How quickly can you get payers to answer your coding questions?

Learn more about the ICD-10 transition
While the deadline is fast approaching, there are still several options that can help organizations prepare for ICD-10. For more information on successful ICD-10 implementation, download Five Steps to Better ICD-10 Clinical Documentation from McKesson Business Performance Services.

Author - Female

About the author

Cindy Cain, BSHA, CPC, CPC-H, CCS-P, CHC is Director for Consulting with McKesson Business Performance Services, an approved ICD-10-CM trainer and an ambassador with the American Health Information Management Association (AHIMA) with more than 25 years of multi-specialty healthcare experience.