With the Right Preparation ICD-10 Updates Can Increase Revenue

Capture-4.pngThe next wave of the ICD-10 transition may help Organizations increase revenue through higher level of specificity in claim submission.  The key to this success is driven by continuous monitoring of coding accuracy.

The introduction of 5500 new codes provides additional specificity and detail allowing for the submission of more specific claims.  Additionally, the end of the CMS amnesty period requires organizations to submit more specific claims or be faced with claim denials.  In order to drive accuracy and reimbursement tomorrow, organizations must have a clear understanding of their coding challenges and opportunities today. AHIMA suggests that organizations assess the initial impact of the 2015 transition to ICD-10 as soon as possible by reviewing charts and denials that are a result of incorrect coding.  These initial assessments can help organizations tailor training and educational activities to the areas which will be most impacted by the changes in October 2016.  

A continuous auditing cycle is vital to assessing the educational opportunities of your coders.  Many organizations take a fragmented approach to auditing, pulling randomly selected charts to confirm they have been coded correctly.  With this traditional approach to auditing, the same coders and the same chart types are typically not re-evaluated.  While organizations may gain a basic understanding of overall accuracy trends, they do not gain insights into the specific deficiencies of individual coders.  Without continuous re-evaluation, education plans will miss the mark and likely not move the needle far enough or quickly enough to take full advantage of the additional specificity requirements beginning in October 2016 and beyond.

The ability to track and measure coding trends is key to measuring performance. It is also imperative that organizations develop ways to gather and provide ongoing education and feedback to their coding staff. Coders must be aware of procedures which can be coded with increased specificity as that specificity may qualify for higher reimbursement when the coding set is expanded.  Both of these needs can be addressed through a continuous audit and education process that provides real-time insight into the performance of coders and works directly with coders to improve coding accuracy.  

With a continuous auditing and education process, organizations are able to track accuracy rates of a specific coder over time, summarize overall accuracy trends over time, identify the specific financial impact of reimbursement errors, and customize coder education and training based on a specific coder’s audit findings which improves overall coding accuracy and maximizes revenue for the organization.  By providing regular education and feedback to coders, organizations can prepare for future updates to the system by maintaining an accurate pulse on coding nuances and opportunities that exist in their specific coding environments.

The arrival of over 5,500 new codes and the end of the Amnesty period is a reminder to providers and HIM professionals that ICD-10 education is a continuous process and did not end with the initial transition in 2015. Ongoing training and audits can help make the next ICD-10 evolution less burdensome and even positively impact organizations bottom lines.

Earlier this year, we launched an auditing solution coined CPI. Our Coder Performance Improvement offering is a solution that focuses on ongoing coder performance and delivered financial upside by identifying and correcting missed reimbursement opportunities.  You can learn more about how this offering resulted in a 10:1 return on investment for one of our clients in our most recent CPI Case Study by clicking the button below. 

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How does your organization plan to manage coding performance during the next phase of ICD-10? I look forward to reading your comments below. 

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Topics: ICD-10, Coding, Audit