Coder Review Technology
Reviews of ICD-10 coding at several health systems in 2015 revealed a predictable pattern of accuracy: 90% for DRGs, 90% for CM, and only 80% for PCS. The financial impact for under-coded cases can be significant. The root cause is ICD-10 PCS, an entirely new very detailed classification that requires the coder to delve into the body of the operative report needed to assign the respective codes. Hence an extensive and continuous review of the codes before the bill finalization is critical to reduce errors and increase reimbursement. These reviews are a requirement in the Office of Inspector General’s Compliance Advice for Hospitals and a common target for RAC Audits.
From assisting significant clients in ICD-10, iMedX is acutely aware of the challenges with the reviews, ranging from reduction in budgets to resource scarcity. iMedX has developed a state-of-the-art review and reporting technology to address these issues – Selene. It not only automates these reviews and integrates with your EMR, but identifies specific areas that the coders repeatedly have issues, thereby providing a platform for continuous improvement. Selene allows you to comply with the ICD-10 requirement to have ongoing external and internal accuracy reviews on a bigger sample size and provide timely ongoing feedback to improve coders’ skills.