What Do Your Payment Results Look Like

Under ICD-10?
By Susan Dooley

Healthcare providers continue to vouch for successful ICD-10 claim submissions, and claims processors
results so far seem in agreement. Revenue cycle management solution provider RelayHealth Financial
recently released its denial rate data for ICD-10 claims processed between October 1 and February 15.
According to RelayHealth, out of 262 million claims representing more than $810 billion in
reimbursement, only 1.6 percent were denied. RelayHealth said that this rate includes only the denial
categories of authorization and pre-certification, medical coding, medical necessity, and untimely filing.
This denial rate, which has stayed steady since November, represents approximately $12.9 billion in
denied claims since Oct. 1st, said Marcy Tatsch, Vice President and General Manager, Reimbursement
Solutions for RelayHealth Financial. She said that since the ICD-10 conversion in October, claim denial
rates had not markedly increased. She also thought another positive offshoot of ICD-10 was an
increased interest in denial management and prevention. However, Tatsch added, the bad news is that
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

as many as 1 in 5 claims is still denied or delayed within the normal hospital and provider revenue cycle
world.

CMS Releases ICD-10 Next Steps Toolkit for Providers

CMS recently released a toolkit intended to help providers assess their ICD-10 progress against key
performance indicators. The ICD-10 Next Steps Toolkit helps providers identify and address
opportunities for improvement and maintain progress on ICD-10 revenue cycle management. The toolkit
is also available as a handy infographic. It suggests a three-step approach to tracking and improving your
ICD-10 progress.

1. Assess Your Progress

First, identify key performance indicators, or KPIs, such as days to final bill, defined as the number of
days from time of service until the provider generates and submits a claim. A few other KPIs to consider
tracking include days to payment, claims acceptance/rejection rates, and claims denial rates. The toolkit
includes a list of 20 possible KPIs to track, but advises that not all of the KPIs will be relevant for all
practices. Its best to compare metrics with past calendar years by month, because some statistics are
seasonal, and because local issues within your practice, such as staff vacations or flu season, will need to
be accounted for as well. Its also a good idea to track KPIs separately for each payer so you can better
isolate the root cause of any problems that are discovered.

2. Address Your Findings

Here, the toolkit suggests developing ways to gather and address feedback, and checking clinical
documentation against code selection. You should also verify installation of all your system upgrades
and work with payers to resolve any billing issues.

3. Maintain Your Progress

To keep your systems current, youll need to make sure your coding tools are up to date. Just like its
predecessor ICD-9, ICD-10 is updated every year on October 1. The ICD-10 Coordination and
Maintenance Committee is an interdepartmental committee coordinated by Centers for Medicare and
Medicaid Services (CMS) and the Centers for Disease Control (CDC). The committee reviews requests for
updates to ICD-10 codes at its March and September meetings. You should also make sure you review
the general guidelines for ICD-10-CM, and if your work is based in an inpatient hospital coding
environment, youll want to review the ICD-10-PCS official guidelines too.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

How About You?

How is your ICD-10 progress going? Are your results similar to those that RelayHealth released? Let us
know.

Learn to Measure Your Payment Results Under ICD-10

Feeling a little concerned about your practices status under ICD-10? Not sure how to begin to assess the
state of your revenue cycle? Then youll be interested in Free Financial Health Assessment. We will help
you on assessing whether your revenue stream is growing or shrinking under ICD-10 as compared to
ICD-9. Based on the assessment we will help you with the strategies to improve your revenue flow.
Contact us today to get your free assessment.

Contact Us:
Name: Sam Nair
Title: Associate Director Enterprise Practice
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

Desk: 866 228 9252, Ext: 4813

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com