The Role of Benchmarking in ICD-10

It’s been nearly six months since the US adopted the ICD-10 diagnosis code set. And overall, providers are feeling pretty solid about the transition. But, to truly call the ICD-10 switch a success, we need to look more at the facts than the feelings. And the best way to get straight to the point is to measure your own success through benchmarking. Here’s what you should evaluate:

Claim Rejection and Denial Rates

You should already know your pre-switch average rejection and denial rates (based on data from your claims containing ICD-9 codes). But, if you don’t, it’s imperative that you go pull some data from claims with dates prior to October 1, 2015. As this ACA International article points out, “Benchmarking is a key component to any effective ongoing revenue cycle management strategy.” So once you have your ICD-9 stats nailed down, you can use them as a benchmark for comparing your clinic’s current performance to its success prior to the transition. Why go to all that trouble? Because doing so will help you see whether the transition has had a positive or negative impact on your clinic’s claim acceptance. In this case, the old adage holds true: you really can’t measure what you don’t track. Plus, the more that payers—including Medicare—toughen up on their specificity requirements, the more rejections or denials you’re likely to see. And if that happens, you can use the data you’ve collected to turn that trend around. To do so, narrow down the codes you submit to the ones with the highest volume and value. Once you’ve identified these codes, you can then review the causes for the rejections, and work to resolve and prevent those issues in the future.

Payment Delays

Just because you’re not seeing a lot of claim denials doesn’t mean your clinic’s revenue hasn’t slowed in the wake of ICD-10. That’s because payers can take an average of 42 days to release payments, and you need to be aware of—and comfortable with—these delays. Now, you don’t have total control over this timeline, but when you know how long it takes to get payment from your payers, you’ll have a better idea of how to manage your cash flow. Furthermore, knowing these limitations can help you manage your response to denials, because you’ll have a good idea of how long it’ll take for a resubmission to be paid. And while you’re at it, this ICD10Watch article explains that “ICD-10 presents an opportunity for process improvements that will enhance the entire revenue cycle.”

Coding Questions

When your staff has coding questions, you should be making note of those questions and ensuring that you—or someone else in your clinic—is following up with answers. If you notice a particular question comes up over and over again, use it as an opportunity to educate your entire staff. Once you start tracking this information and comparing it to your denial and rejection rates, you may find a correlation between the two. As this CureMD article warns, “Negligence in monitoring this information can result in delays and inconsistent coding procedures.” So, the sooner you start managing coding questions, the better.

 

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Benchmarking is the clearest indicator of your ICD-10 success, and now that you know what to look for, you can take the steps to better evaluate your own performance. Are you benchmarking in your own practice? Have questions? Submit them using the form below.