Follow the ICD-10 Conversation.
ICD-10 is one of the biggest regulatory changes to hit the healthcare industry in years. While there are still many unknowns about ICD-10’s impact, organizations can use benchmarking to manage issues that may arise.
How is ICD-10 going for you?
Do you know how your denials compare?
Have your denials increased with ICD-10?
Living with ICD-10
The healthcare industry has been highly anticipating ICD-10 for years and now we have it. Many are asking the question, "Now, what?" Here are a few steps we recommend you take as you adjust to life with more codes than you ever wished for. By taking these steps you can minimize the burden of ICD-10 and adjust quickly and efficiently.
- Start by assessing year over year data trends beginning with October 2014.
- Monitor data trends for
- Reimbursement Reconciliation
- Analyze previous data to determine how quarterly and annual coding updates impact business.
- Determine where ICD-10 is impacting processes.
- Put performance measurements in place to monitor and address issues.
- As trends are identified, take steps to minimize or eliminate the issues for upcoming changes.
- 1. One of the most common reasons for a timely filing denial is inaccurate information from the patient. To avoid writing-off money due to timely filing (Claim Adjustment Reason Code 29) you can develop contract language with your payer that allows the filing period to be extended whenever a patient fails to provide you with correct information. Make sure the contract language clearly outlines the steps that each party must complete for a successful appeal and reversal.
- 2.Use your 2014 data to create benchmarks allowing for an apples to apples comparison and a true understanding of the impact of ICD-10.
- 3.Understanding the top reasons for denials during Q4 2014 will allow for a better grasp on the effects of ICD-10. While Coding is ranked 7th for Q4 2014, some industry experts expect Coding to move much higher on the list by Q4 2015.
- 4.It is important to understand what areas of your business are doing well vs. those that are experiencing a spike in denials. Knowing your denial rates by the type of service will help you drive process improvement that can have an immediate impact on your business.
- 5.The volume of claims processed decreased by 9.63% from Q4 2014 to Q1 2015. Creating benchmarks is key to establishing seasonality trends and understanding what changes in data are based on seasonality vs. industry changes, as a result improving your revenue cycle.
- 6.It is important to understand the average processing times for Q4 2014 to help determine how ICD-10 is affecting the payers as well as your staff processing times. (Note: The average processing time for government payers in Q4 2014 was 13 days)
- 7.It is good practice to understand your denial rates and to prioritize them based on the greatest impact on revenue. Identify the top 3 denials and start to outline the reasons for the denials. Is it a process issue, a lack of information or is the denial due to incorrect usage of a code? By understanding the cause of the denials you can begin to resolve them and begin to achieve greater business optimization.
- 8.As you create benchmarks for your organization it is important to look at internal and external data so that as you set goals and begin to measure your success you have a clear baseline of where you compare to your peers in the industry. This will also help to guide the prioritization of your initiatives.
- 9.One way to ensure that you make the biggest impact on your organization is to look at your initiatives by ROI. Identify the top 3-5 areas to focus. Take a look at the process, the issues and begin to address these high impact areas. This will help guide focus, minimize the impact on your internal resources and show more immediate progress.
- 10.Assess internal and external data to know how your denials compare to your peers on a state and national level. It is important to know the CPT codes with the highest denial rates and where you stand, so that you can have the greatest impact on your business.