November 9, 2015 Nate Seaman in ICD-10

How’s Your ICD-10 Performance So Far?

It’s been just over a month now since ICD-10 launched. Have your months and years of ICD-10 preparation paid off?

Before ICD-10 went into effect, as many as one in four healthcare providers reported that they weren’t ready. Despite these reports, the CMS and large insurers like Humana and UnitedHealthcare have indicated that the ICD-10 rollout has been relatively smooth.

The CMS issued a statement saying that the total Medicare claims denial rate for all reasons is 10.1%, up from a 10% baseline. “That’s a little blip, no more than noise,” health IT consultant  Stanley Machimson told Modern Healthcare.1

“We are about ten days into this and already have 50% of our claims coming in,” said Sid Hebert, who heads up the ICD-10 implementation team at Humana. “Almost everyone who is submitting claims is getting it right.” 2

Does that ring true for you? Do you know if your codes and documentation are specific enough? Do you have insight into how your claims are being paid?

The key to understanding your performance under ICD-10 is tracking your code usage and benchmarking it against your peers. Data analytics with benchmarking can help you truly understand where ICD-10 may be affecting your revenue. Advanced analytics enable you to measure, monitor, and benchmark the impact of ICD-10 so you can identify outliers, prevent denials, and protect your bottom line.

And you can do it all today. Rather than waiting months or years for benchmarking data to be available, you can compare your ICD-10 coding performance now to:

Improve CMI by benchmarking physician documentation down to the secondary diagnosis code level
Benchmark MS-DRG documentation performance against your peers for key metrics such as CC/MCC capture, CMI, and unspecified code usage

By benchmarking your coding and documentation performance against your peers, you can understand exactly where to focus your CDI improvement initiatives, identify how coding and documentation affects denials, and pinpoint how your coding and documentation affect your revenue in an ICD-10 world.

For more information about how MedeAnalytics can help you gain insight from comparative benchmarking data, visit www.medeanalytics.com/revenue-integrity or contact us at info@medeanalytics.com.