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Smoothly Transitioning to ICD-10: Start with Benchmarking Business Metrics

Over the last few months, there seems to have been an endless string of stories focused on the how ICD-10 will change the entire industry – specifically how clinicians will be impacted. While the clinical side will need to ensure more detailed documentation occurs, the business side of healthcare will also have to adjust their workflow and habits for the new code set.

To have a successful ICD-10 implementation, practices are going to have to understand key operational revenue cycle metrics and what they mean to the practice’s bottom line. Here are some suggestions to help manage the business side of ICD-10:

Focus on the data. Benchmarking key business metrics such as average reimbursement rates, time to payment and denial rates is the first step to a smooth transition to ICD-10 from a revenue cycle perspective. Benchmarking both before and after the implementation will allow you to quickly spot any problems with ICD-10 that should be addressed.

Examine the most common codes and payers first. When starting to benchmark, practices should examine their most common diagnoses in terms of both revenue and volume. Your practice can define baselines for future comparisons by collecting data about your practice’s current reimbursement rates, timeframes and denials related to these diagnoses.

It will also be helpful to establish benchmarks for various payers – especially the ones that have the greatest impact on your revenue stream. By reviewing data on these payers, you can catch potentially costly issues before they drastically affect your revenue.

It’s never too early to start. It may seem a little early to begin benchmarking for ICD-10 since the 5010 transition isn’t officially over; however starting the process now will help you return to pre-5010 levels of productivity sooner. Since, most practice’s transactions are being sent to payers as 5010, now is the time to ensure your revenue cycle is back to, or hopefully better than, pre-5010 levels. Make sure benchmarks are stable and accurate as you begin preparing for ICD-10.

The more data you collect, the better picture you can develop of your current revenue and areas of opportunity. Setting up a process for continuously collecting, analyzing and comparing data across time will help you prepare not only for the ICD-10 implementation, but also all other large-scale transitions that are sure to follow.