Hot Topics and Data Analytics in ICD-10. Carrie Aiken, CHC Compliance and Consulting Manager

Transcription

1 Hot Topics and Data Analytics in ICD-10 Carrie Aiken, CHC Compliance and Consulting Manager Today s Presenter Carrie Aiken SVA Healthcare Services, LLC aikenc@sva.com 1

2 Objectives Address any Parking Lot issues Hot Topics - EHR/Billing Software - ICD-10 data analysis - Revenue Cycle performance Brainstorming Open discussion Takeaways, shared ideas, and solutions Parking Lot Issues Source Impacts Ideas Resolutions 2

3 EHR How many FQHCs are using? Any upgrades/releases? Revising templates or fields? Interfacing with other systems? Sharing formats and workflow information? EHR Access behind the scenes? - Diagnosis/problem lists - Reminder/screening triggers Compliance features - Copy and paste - Recall from prior visits 3

4 Billing Software Any upgrades/releases? Revising fields? Interfacing with other systems? Access to databases, tables, behind the scenes? - Including remittance posting - Work queue mapping ICD-10 Diagnosis Analysis Process Top diagnosis codes by volume Map GEMS and manual code review Evaluate practitioner by practitioner Uniform data period Flag ICD-9 diagnosis codes with 4-5+ ICD-10 diagnosis code options Documentation review and improvement Education 4

5 ICD-10 Diagnosis Analysis Visual ICD-9 Codes Diagnosis Info Description ICD-10 Code Qty 2014 Diagnosis Frequency Dr A Dr B Dr C Dr D Dr E PNEUMONIA, 486 ORGANISM NOS SYNCOPE AND COLLAPSE HEADACHE ABDOMINAL PAIN-SITE NEC DIZZINESS AND GIDDINESS ALCOHOL ABUSE UNSPEC HYPERTENSION NOS ICD-10 Diagnosis Analysis Coding Analysis What data are you using now to evaluate diagnosis trends? Do you have other options for nonspecified codes? Do you have resources to translate this data? 5

6 Denial Analysis Process Run top denial codes Denial code (internal) or remittance/remark (payer) Evaluate by payer Uniform data period Flag denials with coding influence Denial Analysis Common Coding Related Denial Reasons/ Remarks CO-9 - Diagnosis is inconsistent with the patient's age CO-10 - Diagnosis is inconsistent with the patient's gender CO-11 - The diagnosis is inconsistent with the procedure CO-50 Non-covered due to lack of medical necessity CO-167 Diagnosis is not covered 6

7 Coding Denial Analysis Denial Info January to March 2015 reporting Denial Message Description Medicare Medicaid BCBS Humana CO-50 Medical Necessity CO-11 Diagnosis is inconsistent with the procedure CO-167 Diagnosis is not covered CO-10 CO-9 Diagnosis is inconsistent with the patient's gender Diagnosis is inconsistent with the patient's age Denial Analysis Further drill down to discover root cause By practitioner By procedure By diagnosis code By coder By modality medicine, behavioral health 7

8 Denial Analysis Are you running reports now? Are staff posting all payments and denials to enable reporting? How are you resolving repeat denials? Has this resulted in documentation improvement or changes? Denial Analysis How has resolution involved payers? Have you developed any EHR or software edits from denials resolution? If you have managed and analyzed denials what revenue or cost improvements have you seen? 8

9 Revenue Cycle Performance Process Determine what core reporting metrics are important to you - Denials/appeal ratios and frequency - Charge lag/turnaround - Payment posting lag/turnaround - Productivity - Revenue All these are coding impact areas Revenue Cycle Performance What core metrics are you measuring? Is this manual or electronic? If electronic, are you measuring all charges or a representative sample? If electronic, is reporting within software or external? Are you comparing month-to-month, by quarter, or annual comparison? 9

10 Revenue Cycle Performance Are you measuring against industry benchmarks or comparing with other FQHCs? What is your risk tolerance on a decrease in performance on metrics after ICD-10 transition? Can you weather a reduction in funding if your FQHC has a sustained decrease in production? How will staff participate in the measurement process? Other Ideas, Solutions, etc Do you have other strategies for ICD-10? Anticipated issues you have already resolved? Challenges where you need help with strategy? 10

11 Q & A References CMS ICD-10 Implementation Planning mentationplanning.html AHIMA Don t Deny the Denials /bok1_ hcsp?ddocname=bok1_ Medscape ICD-10 Guide for Small and Medium Practices WEDI ICD-10 Critical Metrics sment_swg_white_paper_icd10_metrics_revised_ pdf.pdf 11

12 Thank You 12