ICD-10: Focus on Assessing & Maintaining

It has been six months since the U.S. healthcare industry has implemented ICD-10. By all accounts, the transition has been unremarkable, certainly not the chaotic Y2K mess that many had predicted. But that does not mean the work is over. Earlier this month the Centers for Medicare and Medicaid Services (CMS) released and ICD-10 Next Steps for Providers Assessment & Maintenance Toolkit to help healthcare providers work through any problems tied to implementation.

This kit is divided into three sections:

  • Assessing progress by examining Key Performance Indicators
  • Troubleshooting problem areas
  • Staying up to date

In this post, we will summarize some of the key points from each section. However, we encourage all our readers to read the full document which can be viewed by clicking here.

Examining Key Performance Indicators

By tracking and comparing key performance indicators, or KPIs, you can identify and address issues with productivity, reimbursement, claims submission, and other processes. Hopefully, your practice has been conducting regular practice assessments all along. This will allow you to use the pre-ICD-10 data as your baseline for post-ICD-10 metrics.  If you haven’t, you will need to do a little legwork to establish a baseline. Work with your billing and coding staff to see what data is already available in your systems, reports, and records.  You may also need to reach out to your EHR vendor or clearinghouse partner for additional information.

CMS recommends a number of different KPIs for practices to track. Identify the ones that make the most sense for your practice goals and objectives. Here are just a few to consider:

  • Coder productivity—number of medical records coded per hour; review by individual coder
  • Incomplete or missing diagnosis codes—number of incomplete or missing ICD-10 diagnosis codes on orders
  • Daily charges/claims—number of charges or claims submitted per day
  • Payer edits—number and reason for edits required by payers
  • Payment amounts—amounts provider receives for specific services (focus on high-volume, resource-intensive services)

Compare the data pre- and post-October 1, 2015. This will help you detect problems and identify opportunities for improvement. Once you know what the problems are, you can evaluate them to find the root causes and ultimately improve your office’s productivity. Be sure to reevaluate your KPIs on a regular basis as you refine your processes. We recommend a monthly ICD-10 assessment.

Troubleshooting Problem Areas

After conducting your assessments and identifying the problem areas it is time to troubleshoot. CMS recommends that practices develop a feedback system that allows your team members to easily gather and act on issues. Create an issues list where staff can document new issues as they arise. Include in it the issue description, steps to resolve it, issue owner and the current status.

Identify a physician champion staff can turn to when they have questions. Your champion can help staffers understand issues with clinical documentation, offer advice on implementing improvements, and serve as a liaison between managers, physicians and clinical staff.

Staying Up to Date

Lastly, CMS recommends you keep your systems and coding resources up to date. ICD-10 updates take place annually on October 1. Be sure to keep all your systems and coding tools up to date, and to review the ICD-10-CM and ICD-10-PCS General Coding Guidelines on a regular basis. With quality reporting and other requirements, it’s more important than ever that you update your coding resources at least annually.