ICD-10 Changeover: Preventing Revenue Loss in Your Practice
ICD-9 has about 14,000 available codes and this will increase to 68,000 codes when ICD-10 is implemented on October 14, 2014. The transition from ICD-9 to ICD-10 will benefit physician practices, patients, and the broader healthcare system with improved healthcare documentation. ICD-10 will provide a better understanding of diseases and costs on account of enhanced clinical specificity. However, though estimates of the costs of implementing ICD-10 vary widely, there is no doubt that the changeover will result in a productivity gap. It is reported that the coder productivity levels in many of the countries that have switched to ICD-10 have dropped suddenly following implementation. For instance, Canada faced a drop in coder productivity of approximately 40 percent at the outset, while the long-term productivity loss stabilized at 20 percent, never returning to the ICD-9 medical coding levels.
Based on this data, the Health Information Management (HIM) leaders estimate that coder productivity will witness a 20 to 40 percent decrease in the United States following the ICD-10 changeover. It is essential for healthcare practices to prepare for the ICD-10 transition so the impact on their revenue is minimized. If the right measures are not implemented, it could cause a delayed cash flow and even lost revenue. Here are some measures to protect the bottom line of your practice while making the transition to ICD-10.
Education and Training
Medical coders must be educated and trained on ICD-10. When they start using the codes, it will be possible to determine how productivity changes over time. The successful ICD-10 implementation depends on having a coding team that is ICD-10 ready. As per the American Health Information Management Association (AHIMA), it would take about 50 hours of training to use the new code set efficiently. The options available for training coders are:
Measuring and Projecting Coder Productivity
The only way healthcare organizations can prevent medical billing backlogs and protect their cash flow is by measuring coder productivity accurately. Take an organization that has 12 coders, each generating $12 million each day. Suppose that with ICD-10 implementation, the organization suffers a productivity loss of 40 percent. This would generate $7.2 million (instead of $12 million), resulting in a $4.8 million backlog per day. This means that the organization will have a backlog of $36 million at the end of five days, negatively impacting revenue flow and the ability to meet overheads.
In order to measure the productivity and accuracy to address ICD-10 productivity shortcomings, healthcare practices should collect and aggregate quantified data from both onsite and remote coders when they actually apply ICD-10 codes to the patient charts. Double-coding and translation software give an unreliable view of coders’ performance as they apply new code sets to patient charts. Moreover, the use of such software implies that organizations must manually measure and track coding accuracy and productivity loss, which can be a problem in the case of remote coders. The best way to measure productivity is through platform-based training programs.
Expanding Your Coding Team
Once the organization is able to forecast the coder productivity levels, they can use that information to hire short- and long-term staffs to mitigate the gaps. However, they would not have to worry about productivity issues with medical coding outsourcing. Partnering with an established medical coding company would assure healthcare providers of the services of an professional team of AAPC-certified coders who trained and ready for ICD-10.
Based on this data, the Health Information Management (HIM) leaders estimate that coder productivity will witness a 20 to 40 percent decrease in the United States following the ICD-10 changeover. It is essential for healthcare practices to prepare for the ICD-10 transition so the impact on their revenue is minimized. If the right measures are not implemented, it could cause a delayed cash flow and even lost revenue. Here are some measures to protect the bottom line of your practice while making the transition to ICD-10.
Education and Training
Medical coders must be educated and trained on ICD-10. When they start using the codes, it will be possible to determine how productivity changes over time. The successful ICD-10 implementation depends on having a coding team that is ICD-10 ready. As per the American Health Information Management Association (AHIMA), it would take about 50 hours of training to use the new code set efficiently. The options available for training coders are:
- Translation Software – This software automates the mapping of ICD-9 codes to ICD-10. Though it significantly reduces the effort needed to identify codes, this software will not help them understand when to appropriately apply different ICD-10 codes, which is imperative for regulatory compliance as well as reimbursement.
- Double-Coding and Dual-Coding – Double-coding is coding natively in ICD-9 and then again coding in ICD-10 while dual-coding involves the use of tools which can generate simultaneous ICD-9 and ICD-10 code output. Though both methods have the advantages of automatic mapping and code assignment, they cannot provide real-time educational responses to ensure compliance. Moreover, these methods do not provide benchmark data which can help health care organizations measure coder productivity and its impact on reimbursement.
- Platform-based Education – With platform-based ICD-10 training programs, coders can practice on real charts and their own Electronic Health Record (EHR). This can help identify the areas of concern in real time so that the coders can be given additional training. This system also allows coding data to be measured and aggregated to provide a precise picture of productivity and accuracy levels which the medical practice can track over time to see if productivity has decreased, increased or leveled out
Measuring and Projecting Coder Productivity
The only way healthcare organizations can prevent medical billing backlogs and protect their cash flow is by measuring coder productivity accurately. Take an organization that has 12 coders, each generating $12 million each day. Suppose that with ICD-10 implementation, the organization suffers a productivity loss of 40 percent. This would generate $7.2 million (instead of $12 million), resulting in a $4.8 million backlog per day. This means that the organization will have a backlog of $36 million at the end of five days, negatively impacting revenue flow and the ability to meet overheads.
In order to measure the productivity and accuracy to address ICD-10 productivity shortcomings, healthcare practices should collect and aggregate quantified data from both onsite and remote coders when they actually apply ICD-10 codes to the patient charts. Double-coding and translation software give an unreliable view of coders’ performance as they apply new code sets to patient charts. Moreover, the use of such software implies that organizations must manually measure and track coding accuracy and productivity loss, which can be a problem in the case of remote coders. The best way to measure productivity is through platform-based training programs.
Expanding Your Coding Team
Once the organization is able to forecast the coder productivity levels, they can use that information to hire short- and long-term staffs to mitigate the gaps. However, they would not have to worry about productivity issues with medical coding outsourcing. Partnering with an established medical coding company would assure healthcare providers of the services of an professional team of AAPC-certified coders who trained and ready for ICD-10.
Comments