Updated on: March 22, 2016

How Data Analytics Can Help You Prepare for ICD-10

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Original story posted on: October 29, 2012

Now that we have a new ICD-10 implementation date of October 1, 2014, it is time to get back on track. Industry experts agree that providers should be focusing on two tasks: Performing data analytics and finalizing education plans.

As you may know, Talk-Ten-Tuesday airs every Tuesday at 10 a.m. Eastern time at www.TalkTenTuesday.com. At the start of this 30-minute broadcast, we poll our listeners on a current ICD-10 topic. Our goal is to gather their progress and opinions on the new I-10 system and its implementation, and we have received valuable information on data analytics from several of these polls.

On March 13, 2012, we asked the following question: “When is your organization planning to do your coding data analytics to assess potential revenue impact under ICD-10?”  Our listeners responded as follows:

  • 18 percent had already done their data analytics
  • 51 percent were going to do it in 2012
  • 10 percent will do it sometime in 2013
  • 7 percent are not planning on doing any
  • 15 percent indicated that the question was not pertinent to their organization.

On June 19, we asked: “What financial impact has your data analytics revealed?  Our audience response was:

  • 15 percent are showing a potential loss financially
  • 9 percent indicated a potential increase
  • 12 percent showed potential revenue neutrality
  • 51 percent still haven’t done their data analytics
  • 13 percent indicated that the question was not pertinent to their organization.

A tip for those showing a potential financial loss and for those that see a possibility of an increase: Data analytics is definitely worth doing because if the documentation is not in the medical record, then the most specific I-10 codes cannot be assigned, which will impact your reimbursement.

On June 10, we asked: “What do you think your biggest coding challenge will be with ICD-10?”  Our results showed that:

  • 77 percent believe that a lack of physician documentation will be the biggest challenge
  • 9 percent see staff education as the challenge
  • 9 percent anticipate finding additional coding staff or maintaining current coding staff an issue
  • 1 percent thought it would be inadequate coding tools
  • The question did not apply to 4 percent.

As you see, 77 percent of those responding believe physician documentation will be the biggest challenge—a response that we all saw coming. It’s a wake-up call that everyone needs to start addressing ICD-10 documentation now because, after all these years, we are still struggling with it under ICD-9.

Why Perform Data Analytics?

The more we know about and understand our data, the better “armed” we can be to use, and perhaps improve it, if necessary. Understanding your coded data and how it relates to your financial data is essential. Even though patient care is always a priority, you still have to have financial success to provide it.  Knowing the potential impact of ICD-10—both opportunities and risks—will help you prepare for it.

Another area that you will need to analyze is your case mix. By doing so, you can monitor the diversity, clinical complexity and resources needed for hospital patients. Knowing this will help you to focus your limited budgetary resources. To improve your patient acuity, you will need to educate physicians about how to improve their documentation. Correct coding also will positively impact your case mix.

Clinical performance is another area impacted by coded data. Many organizations, healthcare groups, consumer groups, and others are paying attention to the quality of patient care being delivered, and this scrutiny will continue as we move closer toward value-based purchasing (payment based on quality care and controlled costs). Coded data will be used for measuring and tracking.

Finally, ensure that you reduce your regulatory risk by ensuring accurate documentation and coding.  The primary goal is to reflect the severity of patients and the resources they consume so that you can accurately assign codes and receive accurate payment.

After you perform data analytics, there are two more major steps you will want to take that are described below.

 


 

Perform a Focused Medical Record Audit

To perform this audit, you must review specific discharges that were identified in your data analytics to assess and evaluate current coding and physician documentation. Remember: You also will want to ensure that the MS-DRG and major ICD-9 codes originally assigned by your coders are correct otherwise the general equivalence mappings (GEMs) translation to I-10 will not be valid.

Next you will want to code natively in ICD-10 to identify opportunities for documentation improvement that can be made. The GEMs translation is only a tool to identify potential impact; the true extent for opportunity is in the actual medical record documentation, which is why it is better to use your actual claims’ data rather than MEDPar’s when running your data-analytic reports.

Next, trend the documentation gaps you are finding. You may want to look at documentation patterns by MS-DRG, specialty, physician, diagnosis or procedure to name a few. Also, trend your financial impact to get a true picture based on the actual audit.

Since we still have two more years to use ICD-9, you also may want to identify documentation and coding gaps in your current use of ICD-9. This may depend on your normal coding auditing schedule.

Perform Education and Training

Using your facility’s data, you can identify where you need to focus to reduce your risk and identify your opportunities.  It also will help you target education efforts with your medical staff, clinical documentation specialists (CDSs) and coding professionals. Each facility must assess their own I-10 education needs because one solution does not necessarily fit all.

Coders, for example, need to learn the concepts of ICD-10 and how to use the new system, and they should receive a focused training.  But when you start to review the education needed by physicians or clinical documentation specialists (CDS), you may not know where to start: Should you train in general concepts? Or do you drill down and focus on facility-specific documentation weaknesses?

When developing your education plan, you will use the information you obtained from the audit. You may want to:

  • Prioritize your education program based on areas with the most opportunity and risk.
  • Target sessions by specialty and work with physicians and CDIP staff concurrently on the same topics. Adjust your schedule so that you can accommodate physicians’ schedules, and try to get on the agenda at their already-scheduled meetings. Doing so will eliminate unnecessary meetings for medical staff, and you will be making a low impact on physicians’ times. CDSs should be educated on the importance of documentation details so that they can work with and query physicians, who should get more general information.
  • Assess what tools will work best based on your staff: Do you need to do PowerPoint presentations, develop and provide workbooks, hold classroom-style classes, work on the floors and shadow your CDSs and physicians? These are all options for giving them the education they need.

Finally, you may also want to start addressing query writing and how ICD-10 will impact it as well as what data your CDSs may need to collect in relation to ICD-10.

Next month: A case study

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Kim Charland, BA, RHIT, CCS

Kim Charland is senior vice president, clinical consulting services, Panacea Healthcare Solutions, Inc., St. Paul, MN.