We survived ICD-10. Contrary to popular beliefs, the storm didn’t hit us as hard as we thought and many practices have settled into their new routine pretty quickly.

Some though, just don’t know. They are doing everything they were taught to do, and things seem to be moving in the right direction. Will they get paid? A clearer picture will emerge when remittances start coming in.

Meanwhile, here are a few Metrics to monitor for the first few months into ICD-10.

Coder Productivity

Coder’s productivity will take a hit by as much as a staggering 50%. Although the drop in productivity will vary depending on factors such as the type of institution, training levels and the quality of physician documentation, organizations need to be well-versed in their staff’s productivity in ICD-9 to monitor the decrease under ICD-10.

To ensure that you’re coders productivity remains intact ask yourself the following questions:

• Do coders struggle with one or more than one specialty types?
• How much time is being spent on non-coding tasks, can these be cut down?
• How much more training/education is required? And in what specific domains?
• Are there any gaps in documentation driving productivity loss?
• What community-directed interventions can be performed immediately?
• Should you make changes to the current workflows?
• Should you be using Computer-assisted coding (CAC)?

Read:  5 Things to Ensure Coder Productivity Post ICD-10

The volume of concurrent queries

Your concurrent queries (Received when the patient is still under the point of care of the physician and is readily available to resolve the issue) are most likely to increase, especially with ICD-10-PCS. These require constant monitoring and comparing with your baseline to keep the volumes in check.

Ask for in-depth clinical details to avoid issues in specific documentation. It’s important that you outline an entire policy on queries based on their priority and impact. Keep the following pointers in mind:

• Do the queries have an increasing trend? If yes, are they related to a specific line or provider?
• Should you consider working with a physician advisor to help address these query hikes by providing education?
• Can templates be used to collect additional documentation electronically?

CDI specialists can play a major role here, especially with ICD-10 procedure codes because of their increased laterality and anatomical knowledge required to assign the codes. They have the most immediate knowledge in this regard which your coding staff may or may not be geared for.

Have a collaborative coder-CDI team in place. Their communication exchange should be crystal clear to avoid asking physicians for the same information, causing them to ignore concurrent queries altogether.

Volume of retrospective queries

Your retrospective queries (received after the patient has been discharged) are going to stack up given ICD-10’s specificity for clinical documentation and coding. Establish a benchmark for your retrospective queries in ICD-9 and compare the volume for those with ICD-10. If these are increased by a substantial amount, it’s bad news. It means there’s a wide communication gap between coders and the physicians.

Familiarize yourself with the process and make changes in your workflows to get accustomed to resolving retrospective queries. Have a system in place where you can prioritize these in terms of importance and urgency.

Denial Rate 

There’s nothing to worry about if your coding is correct, however, with ICD-10, this might not be the case. The denial rates are said to rise by 100 percent to 200 percent with A/R days growing by 20 to 40 percent. However, as they say, every cloud has a silver lining, these denials will eventually reduce. In case they don’t, it means you need to re-look into the expertise of your coders in doing the right coding.

Track payer response, together with specific edits and medical necessity denials. What types of edits are there and how often? Have a mitigation strategy in place based on this information.

Read: How will my claim submission process change with ICD-10?

Revenue cycle flow

Keeping revenue cycles intact is the ultimate goal of your practice. Have processes in place that can flag the ICD-10 high alert areas, channel that information into your billing system and undertake required changes to improve your claim submission process. Your A/R days shouldn’t jump! If they do, it means huge cash fluctuations for your practice.

Follow each record type:

• Inpatient, outpatient
• Same-day surgery
• Emergency department
• Recurring accounts (Including Medicare and commercial cases)

Monitor if the record moved through pre-authorization and scheduling to coding/billing and then to the payor. Also, consider outsourcing your billing to a billing vendor.

Days to the final bill

DTFB is the duration during which a provider generates a bill and sends it to the insurance for payments. Delayed charges, physician charting delays, increased documentation specificity requirements and queries are going to increase the DTFB which can affect the AR days for your practice.

This is why it’s a key performance indicator to monitor. Do providers maintain the same level of efficiency and speed under ICD-10 in generating claims as they did in ICD-9?

Days to Payment

The duration it takes for a provider to get paid after claim submission. Although more related to payors than providers, this still remains an important metric to watch because if the insurances aren’t paying as fast as before, it can put a provider’s finances in jeopardy.

Although this number will vary from the payor to payor, it shouldn’t exceed a benchmark number. Monitor which payors are taking longer than usual to make payments and who pay on time.

Coder questions

Increased coder questions are inevitable in the first few months of ICD-10. Although external bodies provide guidance to help coders in ICD-10 guidance such as the American Hospital Association’s Coding Clinic, the organization needs to have a hands-on approach with a system designed to submit coder questions internally to a chosen expert for redressing their concerns and tracking responses. Negligence in monitoring this information can result in delays and inconsistent coding procedures.

Quality assurance 

Quality is doing things right when no one’s looking. Have quality assurance programs in place for both coders and CDI specialists. Audit your high-risk cases in the initial days to identify a trend of incorrect coding before someone else points it out for you. These can be performed by coding educators prior to claim submissions. Also, this monitoring process needs to be an on-going activity into 2016 and beyond.

 

All in all, the metrics discussed above are those which require close monitoring in these initial days of ICD-10 transition. The whole purpose is to make sure that you identify problems early and nip them in the bud when they are still manageable.

CureMD’s All-in-one Cloud platform and in-depth ICD-10 resource center can further help you in your initial glitches for a smoother and leaner ICD-10 implementation in the long run.