Among the many threats to a medical practice’s bottom line under ICD-10 is coder productivity. But as Carl Natale of ICD-10 Watch says, “Productivity does not have to be fatal to your medical practice.” While practices and billing companies do well by continuing to monitor claims submissions, denials, and payments, they should also take steps to track and improve coder productivity.
Know What You Are Aiming For
Perhaps the best way to know what productivity numbers you are aiming for under ICD-10 is to determine your average productivity under ICD-9. Since the basic methods of assigning codes remain the same, eventually you can expect your coders to achieve that same level of productivity again. Begin making monthly comparisons so that you can watch the progress and encourage your coders.
If you haven’t previously tracked productivity, Deb Greider, a Clinical Documentation Improvement Practitioner, an AHIMA-approved ICD-10 trainer, and an American Medical Association coding author, offers the following standards in a recent ICD-10 Monitor article, though your numbers will vary depending on many factors.
|Type of Claim||Records per Hour||Records per Day||Avg Time per record|
|Emergency Department||15||120||4-5 minutes|
|Ancillary services||30||240||2-3 minutes|
Give It Time
According to Natale, the reasons productivity will diminish in the early days after ICD-10 are obvious: the code set is unfamiliar, the specificity requirements will generate more clinician queries, coding errors and claims system errors both will require coders to go back to charts that have been denied or rejected.
With time, many of these problems will resolve themselves. The more time coders spend in ICD-10, the more familiar and more accurate they will become. Likewise, after an initial wave of queries, clinicians will naturally improve their documentation to some degree. And in general, the industry will correct errors and increase communication and everyone will grow more comfortable and adept at ICD-10.
This may seem obvious, but just because coders are now working under ICD-10 doesn’t mean they know the new code set or guidelines completely. Continue to budget resources and time for your coders to receive additional training. A well-trained and well-prepared staff will be more productive.
Anywhere you can automate the processes coders use, you are improving their productivity. One way to do that is computer-assisted coding (CAC). CAC can do a lot of the heavy lifting for coders who then must just verify coding information, says Melanie Endicott, Senior Director of HIM Practice Excellence, Coding, and CDI Products Development at AHIMA. However, implementing a CAC during the first few weeks of ICD-10 implementation is probably not the best strategy. “Organizations should consider implementing CAC … even after ICD-10 implementation to ensure that coders are not over-burdened with too many changes,” Endicott suggested in a recent RevCycleIntelligence article.
In addition to CAC, consider how you might automate tasks like chart reconciliation, transmitting coded charts to the next person along the revenue cycle, and provider inquiries with spreadsheets, EMRs, task queues, and other workflow tools.
“Carefully planned automation can boost efficiency and productivity,” writes Natale.
Another way to increase coder productivity is to limit the number and scope of work each coder is doing. Angela Carmichael, a HIM Product Development Specialist for J.A. Thomas & Associates, suggests having each coder specialize in the type of coding they are doing, whether inpatient versus outpatient, or literally by medical specialty or type of service depending on your practice.
Also, in the early days under ICD-10 when many unresolved charges with dates of service prior to October 1, 2015, are still floating around, designate one or two coders who will still work in ICD-9. Or if that is not possible, have coders work in ICD-9 only at certain times or on certain days.
Manage Provider Inquiries
As clinicians adjust to ICD-10 as well, provider inquiries may increase, especially in the first few months after implementation. Think carefully about your process to avoid coders wasting time looking for returned charts or updated documentation.
Also, determine when you will — and won’t — ask for more detail. Carmichael suggests that not all inquiries may actually be necessary. She offers four guidelines to help you determine when coders will return charts to clinicians:
- will the additional detail improve your data reporting?
- does your inquiry meet the guidance provided in AHIMA’s “Managing an Effective Query Process”?
- is the outcome of obtaining a higher level of specificity worth the cost?
- if the clarification/query does not add to your bottom line, is it worth inundating physicians?
Don’t Forget about Accuracy
Finally, in the quest for greater coder productivity, make sure you aren’t skimping on accuracy. “Most of my clients have set the bar high, between 95-98 percent accuracy,” Greider writes. “The Office of Inspector General (OIG) standard is 95, but the goal to strive for, of course, is 100 percent. Ninety percent is considered acceptable or commendable, but anything that falls below 90-percent accuracy should be addressed immediately.”
We are one month into ICD-10. The transition has been smoother than expected, overall. Now’s the time to begin really thinking about productivity and formulating a plan to ease back to pre-ICD-10 levels.
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