It's been nearly a year since the U.S. health care system upgraded to the ICD-10 code set for outpatient diagnostic coding on Oct. 1, 2015.
By most accounts, family physicians have adjusted well to a new system that increased the number of codes from about 13,000 to more than 68,000.
To ensure that America's physicians stay on track with the good progress they've already made, CMS has created a free ICD-10 Assessment and Maintenance Toolkit(www.cms.gov) designed to help physicians manage their revenue cycles.
This resource aims to assist physicians as they
- assess their ICD-10 progress using key performance indicators to identify issues that could potentially affect productivity and/or cash flow;
- address opportunities for improvement by troubleshooting issues spotted during that assessment;
- deploy tactics necessary for improvement, such as system enhancements and specific staff training; and
- maintain progress by keeping current on ICD-10.
Using Key Performance Indicators
In the first of a series of tips sprinkled throughout the toolkit, CMS notes: "It's best to compare metrics with past calendar years by month. There's some seasonality to statistics, and you will want to take into account local issues (e.g., impact of staff vacations, flu season). Keep this in mind when developing baselines."
Don't have reports with key performance indicators for the year before the October 2015 transition? CMS suggests physicians work with their claims clearinghouse or vendor to access that data and create a baseline.
CMS also provides a comprehensive list of performance indicators physicians should consider tracking, such as
- days to final bill,
- days to payment,
- claims acceptance/rejection rates,
- claims denial rate,
- requests for additional information,
- payer edits, and
- incomplete or missing diagnosis codes.
Physicians need not track all key performance indicators, says CMS, "But even small steps to identify and resolve issues can get you on the road to higher productivity and better cash flow."
Troubleshooting Problem Areas
As part of the troubleshooting process, CMS encourages physicians to create a feedback system that allows for questions from staff who are dealing with the new codes.
For instance, it's important to learn from staff members exactly where ICD-10 is slowing down their work and which codes are causing the most difficulty.
The toolkit prompts physicians to create an "issues list" where staff members can record problem areas as they arise. Specific issues should be tracked and resolved as quickly as possible.
CMS also advises physicians to compare clinical documentation for services provided before and after Oct. 1, 2015, and urges physicians to develop a thorough understanding of their organizations' process for selecting diagnosis codes and applying coding guidelines.
The toolkit provides links to educational resources to help both clinicians and coders and suggests that practices identify a physician champion to help work through coding issues, distribute information and act as a liaison between all parties involved in the coding process.
This ICD-10 resource also guides users through processes for
- identifying systems issues,
- resolving issues with payers,
- conducting hospital chart audits, and
- keeping systems and coding resources up-to-date.
Related AAFP News Coverage
Pre-order for Discount
AAFP Coding Flash Cards Update Includes Risk-adjusted Payment
More From AAFP
AAFP Coding Flash Cards 2017