The ICD-10 Coding Vacation is Over

The ICD-10 Coding Vacation is Over


Ever been on vacation?  We all have.  The lead up, ripe with excitement and anticipation. The unknowns. The spontaneous confidence that something big is going to happen.  The day finally arrives. Perhaps a plane trip. Activity-filled excursions. The suntan. Mimosas or a Dark-and-Stormy, garnished with some island music.  Good food, a good book, and lots of rest!  But then, before it even starts, you are back home in the grind. The party is over.


And so is the ICD-10 implementation that kicked off October 2015.  Debate about its effectiveness, ability to help control costs, and whether there will be enough qualified coders to do the work was in hyper warp mode.  But finally, right or wrong, the standard was codified and required.


As we approach the 1-year anniversary of ICD-10 in the United States (no one is breaking out the Champagne), there will be another (almost) 6,000 codes released (as if the original amount wasn’t enough!). Along the way, experts in the coding world have been busy auditing and assessing program efficacy, as well as the accuracy and specificity of coders and health-care systems nation-wide.


What have they learned?


According to study conducted by ICD10 Monitor, the overall average accuracy during the 1st quarter 2016 for inpatient, ambulatory, and emergency coding types has dipped to as low as 80%, far lower than the 95% industry standard inherited from the days of ICD-9.  Digging deeper, the study revealed that for some coding categories, the accuracy approached a dismal 50%.  While audits indicate an uptick in accuracy during 2016YTD, the industry effort continue to fall short of the mark and has reduced productivity by as much as 15% (Source: Becker’s ASC Review).  Of course this is clearly on the lower end of the scale when compared to pre-October 2015 estimates (10 to 50 percent productivity impact), it is still a downward trend that has substantial monetized effects.


So, what to do?


Perform you own internal audits. Do them more often.  Conduct them with greater rigor.  Ask yourself these questions:


  1. Does my facility use EMR? Do we dictate?
  2. How is my hospital, clinic, or practice entering the codes? By hand? Drop down lists? Are the lists complete and accurate, or do they enable the coder to derive errors through repetition?
  3. What are the coder knowledge gaps? What is the mixture of highly trained-and-certified in-house coders versus outsourced coders?
  4. Now that ICD-10 is well underway, what are you doing to maintain a robust continuous training program, especially as codes are added, grace periods are depleted, and accuracy thresholds are increased and expected?
  5. Is your clinical documentation complete and accurate?
  6. Are physicians providing ICD-10 quality notations or are there inherent and systemic quality gaps, requiring several iterations, thereby reducing productivity?


Some proforma and upside considerations:


  1. While you can enter memorized ICD‐9 codes in your search, learning the recommended search strategy for your EHR may yield higher quality results.


  1. Take advantage of specific coding when you have sufficient detail or knowledge to assign a more specific code.


  1. Codes can be refined to indicate laterality, cause, type and chronicity


  1. ICD‐10 codes can now account for disease relationships indicating higher patient acuity (e.g., how many elderly diabetics do you know who actually have no complications?)


Remember that the transition flexibility with the family of code (ICD‐10 three‐character category), is slated to end September 30, 2016.

The upshot? There are a lot of internal, as well as external actions to your medical documentation systems involving accurate transcription and coding.  Doing those things isn’t enough – you must do them accurately and with minimal interference to productivity, maximizing reimbursement and quality of care.

Maybe then we can go on vacation again.  Daiquiris on the house!

For further information about how iData can assist you in the transcription and/or coding space, please contact us at 888-932-6922 or visit us at to learn more.

Calculating Costs of Outsourced vs. In-House Transcription

Did you know?
We often take our environment for granted.  At work or at home, whatever it is we’re doing, we tend to keep doing the same thing.  As the old adage says, “things in motion tend to stay in motion; things standing still tend to stay still” – an artifact from thermodynamics.
And so it is with clinical documentation, especially transcription, and today coding as well.  For years, hospitals go about doing whatever it is they’re doing and keep doing it, despite facing increasing economic and regulatory pressures, competition, insurance pinch points, consolidation, and so on.  Sure, we can all agree that we’ve seen many changes over the course of the last 25 years looking at them with the wide-angle lens of critical analysis.  Yet, it still takes a lot of inertia and momentum to move any programmatic train on the rails of progress.
To abuse the binary term “core competence”, transcription is one of those skills that has never been, nor will ever be, a “core competence” for hospital work space.  Hospitals are for healing the sick, not for typing recorded media. Remember, the operative term is “core” – not that it can’t be done in-house (duh, its done all the time!), but the argument for outsourcing transcription is steadily growing post-ICD-10 implementation. Moreover, the opportunities are just limited to domestic on-shore outsourcing – this area of the industry has gone through time-warp improvements that are worth considering from a life-cycle cradle-to-grave analysis.
The list below is not rocket “surgery” (pun intended), but it’s worthwhile reinforcing the fundamental truths about why your hospital (or clinic) should revisit the idea of outsourcing. Trust us, as we mentioned above, this is the stuff we take for granted:
1. Minimize Carrying Overhead Costs:
The amount of effort involved in task-specific and human management, administration, hiring, firing, fringe and all-in labor costs, document and queue management, QA, systems management, etc. can be overwhelming. Partnering up with a qualified and proven transcription provider eliminates these headaches, and internal resources are better spent on health care.  The opportunity to capitalize on wholesale and economy of scale contractual agreements and line costs aren’t left on the table with outsourcing.
2. Improved TAT and Quality:
From STATS to run-of-the-mill transcription, using an outsourced medical transcription service provider ensures a continuous stream of coverage, quality, and response – regardless of the volume and variability.  Hospitals and clinics will no longer have to carry the burden of billable hours or lines for light periods.  Without outsourcing, your facility pays for the salary and benefits of your in-house transcriptionists no matter their productivity!  Outsourcing flattens out the utilization and expense curve over the long run to your benefit! Moreover, in the world of ICD-10, it is essential that auditing, quality improvement, training, and quality assurance are employed effectively and are compliant with all stakeholders.
3. Reduced Front and Back-end Capital Expenses:
In-house transcription means equipment and software purchasing, systems integration, maintaining, upgrading, securing, and archiving your own transcription – it comes at a headache, laden with liability, and at a cost!  Outsourced transcription reduces budget line items on the capital and expense side, as well as secondary and tertiary softer benefits such as peripheral hospital equipment costs (e.g., copiers and fax machines), IT services, etc. which are desperately needed elsewhere in the growing competitive health care “we-have-to-answer-to-the-investors” environment.
Still, there are many other softer benefits that hospitals and clinics can reap from once an outsourced medical transcription service provider is screened, hired, and integrated into your hospital or clinic environment.  You should be able to easily do a back-of-the-envelope line item cost analysis for your in-house transcription and compare it against an all-in life-cycle whole-sale outsourced medical transcription option.
So, what are you waiting for?  Get out that old envelope from the recycle bin and jot some numbers down.  Then pick up the phone and explore the outsourcing transcription and coding opportunities that have evolved and are waiting to benefit your organization!
And lastly, partner with a US company that can allow you to grow your volume and maintain your target metrics.  I look forward to talking with you soon.


Speech Recognition Volume Solutions

Whether you are a Medical Transcription back office supplier, or you a working in a hospital or medical practice, here are some very important thoughts and questions for you to consider around Speech Recognition:
For Medical Transcription providers:
Are you struggling as a company to manage SR volume while staying compliant on TAT?
If you had more capacity, could you grow your volume with your SR customer?
Are you struggling with how to price SR?
For Hospitals and Medical Practices:
If you had a proven partner that could provide excellent service at a competitive price point, would you be willing to explore another company?
Are you having trouble maintaining TAT on your SR platform?
Do you need another company to help hold your existing vendor accountable?
If any of these questions “hit the mark”, please consider contacting iData.  iData has been in the medical documentation space for over 10 years with an exceptional track record that isn’t just fancy words.  We really do deliver high quality results, often exceeding quality and TAT targets at an attractive price.  How? We simply know what we are doing.  Our team has streamlined the work flow process, introduced system efficiencies that other providers simply don’t have, and offer a personalized, customer-and-end-client-focused attention to meet your needs.  We offer a competitive price-points with volume discounts. Wash, rinse, repeat.  Its that simple.
Partner with a US company that can allow you to grow your volume and maintain your target metrics.  Contacts us now to discuss running pilot test with your organization.

Call 888-932-6922 Now!

Let iData Dictate your Discharge Summary Reports and Reduce your Discharge Not Final Billed (DNFB) Rates

Let iData Dictate your Discharge Summary Reports and Reduce your Discharge Not Final Billed (DNFB) Rates

Reduce your Inpatient Discharge Not Final Billed (DNFB) rates and see increased revenues using iData’s plug-and-play workflow process. iData has combined its 3-prong knowledge of medical transcription, coding, and EMR-based Discharge Summary Reports (DSR) to offer your facility an opportunity to potentially capture hundreds of thousands of dollars in lost or delinquent revenue. Check out our simplified workflow process which exploits existing client EMR and system data to dictate and complete a DSR, transcribe it, and code it. Returned DSRs enable physicians to review, sign off, and decrease a facility’s DNFB rates without virtually lifting a finger. Want to learn some more? Call iData at 410-212-7935 and talk to us about your DNFB rates, DSRs, or any other of iData’s suite of medical documentation services. We would love to help you!




The World of Medical Transcription and Speech Recognition (SR) according to iData

The World of Medical Transcription and Speech Recognition (SR) according to iData


Speech recognition. You’ve thought about it. Maybe you’ve tried to use it commercially several years ago with frustratingly mixed results. Nuance Dragon made it available beginning with an App for the 1st generation iPads. You got choppy, inaccurate, and hard-to-edit speech-to-text conversion. Then you gave up.


That was 6+ years ago. The technology, along with facial recognition, music, image, and video recognition software has emerged and has rapidly improved, yielding better and better user-interface results. Consider the following:


Instagram, Facebook, Snapchat, Google, Android phones, iPhones and other Apple products, camera software and Apps can now identify faces and assign names. Products like Shazam can “listen” to sounds or videos and identify music, songs, or movies playing on TV. Google image search and Pinterest can find exact or similar images to an image you upload or photograph. Google search and the emerging Big Data markets do the same thing, but on an exponentially more complicated paradigm. And now we have “Hey Siri”, “OK Google” and “Hi Galaxy” to ask our phones just about any question with reliable results.


Behind these technologies lie very similar algorithms and input-output engines that collect data, compare the data, process the data, and spit out results. And so it is with Speech Recognition in the healthcare and medical transcription world. In the interest of expediting reports or reducing costs, a physician or other medical staff records information into a device or phone. The software transcribes the audio in real time (instant TAT, right?).


So it’s easy to see, if you haven’t already, that SR is here and here to stay. The technology is getting exponentially easier to use, with lighting fast results, more accurate, and (importantly) increasingly attractive cost-effective way to do business.


iData, LLC, is a U.S.-based medical documentation service provider in the transcription and coding space. We have over 10 years of experience with national and global clients and have now, more than ever, immersed our business in the SR realm to help clients achieve their business goals with fast (TAT), accurate (quality), and cost-effective solutions. Whether you are new to this technology and considering to flip your medical practice to speech recognition, or already are integrated into platforms like Nuance’s Escription, or M*Modal’s Fluency, iData can assist you in designing a work flow, integrate your current business, and implement an SR solution that keeps more dollars on your Balance Sheet. iData is experienced with these and other SR platforms and can offer recommendations depending on your scope and KPI’s. Both Nuance and M*Modal have pros and cons, although both have bragging rights, awards, and years of market leadership. They dominate in the US healthcare market.


So whatever your speech recognition needs, contact iData at (410) 212-7935 today to discuss your next steps. Have you “recognized” that speech “recognition” may be your solution to better transcription?

Forget October 1, Are You Ready For October 16?

Forget October 1, Are You Ready For October 16?

We were all focused on the start of ICD-10, but in a few short weeks healthcare organizations will begin to see the impact of the transition on their bottom lines. Here are some tips on how to mitigate the ICD-10 impact.

ICD-10 implementation and planning has been a like a dust storm looming on the horizon: swirling, unpredictable, and a somewhat painful experience. Because of its erratic nature, for the most part, we have all been focused on the challenges of meeting the deadline. We’ve been preparing, planning, allocating resources, testing, tweaking, and testing again. But what most of us haven’t been planning for are the days and weeks post October 1.

A few weeks into October, organizations saw the positive and negative impact of the new coding practices and outcomes on their revenue cycle. With a large-scale transition like ICD-10, and the massive volumes of cases now being coded using the new system, there will be gaps — no matter how well prepared your organization is, we all must carefully examine our plans and processes.

This is the time to embrace ICD-10 in terms of people, process, and technology. Re-examine your workflow and plans to measure the accuracy, quality, and productivity around the new code set. Here are some recommended steps for mitigating the ICD-10 impact and maintaining data integrity post October 1.

All Codes Are Not Equal
Hospitals and providers need to implement regular audits to evaluate the accuracy of the ICD-10 codes and determine the areas of greatest impact on their organization. With this auditing schedule (I suggest daily and weekly at the beginning, and then transition into monthly), you should also define your metrics for monitoring, as well as a project plan that includes resources and tools, timelines, and specific reports or deliverables. You can use these audits to determine the areas of highest impact, and create a plan for prioritizing and targeting those key areas that are causing the most concern: clinical specialty, physician, CDI needs, or coders to mention a few.

Work With Your Physicians
Once you’ve identified the key areas of high-impact denials, meet with your physicians and clinical documentation specialists to review the required clinical documentation needs for ICD-10 coding best practices. Targeted training and increased awareness about enhanced specificity on a patient’s current conditions reflected in the clinical documentation, or the tests and procedures being performed as a result, can have a profound outcome — both on the continuity of care as well as on compliance, quality scores, and reimbursement. For instance, improving the appropriate and precise clinical documentation for a patient with congestive heart failure will not have the same impact as documenting a patient admitted with severe nausea and vomiting. Reporting and analytics tools can be helpful for identifying clinical specialties and/or particular physicians whose documentation may be lacking the proper levels of specificity.

Measure, Measure, Measure
While some clinical documentation improvement metrics are available, currently there are no industry benchmarks for ICD-10 productivity and/or accuracy. Meet with your team of coders, coding trainers, auditors, and clinical documentation specialists (CDSs) and determine your expected turn-around times for discharge processing and coding, discharged but not final billed (DNFB), and days in medical accounts receivable (AR). Create your own ICD-10 accuracy and productivity targets and metrics and be sure to share with the coding team so everyone is well informed of the evaluation and auditing methods that you will be deploying under ICD-10. Infuse continuous quality improvement (CQI) into your cycle of identifying, reviewing, and evaluating each step; and use your reporting tools and audits to track progress, identify areas for further improvement, retool remediation strategies, and share feedback. This is in addition to tracking metrics such as your diagnosis-related groups (DRGs), case mix index (CMI), and severity of illness (SOI), of course!

There undoubtedly will be hiccups here and there, but having pertinent clinical documentation appropriately entered by physicians at the point-of-care is still the best way to tackle ICD-10-related challenges, in addition to providing tremendous relief to both coders and CDSs, and simultaneously reducing physician frustration levels associated with the querying process. Tools such as computer-assisted physician documentation (CAPD) and computer-assisted clinical documentation improvement (CA-CDI) can be extremely useful, particularly if your organization has narrow bandwidth of staff. The outcome that results from having technology-enabled solutions of real-time specificity physician prompting can help to improve clinical documentation integrity and boost your outcomes reporting that can have a real impact on institutional as well as professional credibility.

While October 1 was an important day for us all, what is even more significant is what will happen in the days and months following the compliance date. ICD-10 is a powerful reporting system that will help improve the accuracy of the patient record and ensure quality care. Making sure your organization has a post-transition strategy in place will help you quickly address any unplanned associated complications.

4 Tips for Success – ICD-10 Conversion and Implementation

4 Tips for Success – ICD-10 Conversion and Implementation


From Cedars Sinai presentation at the AHIMA conference, the following lessons learned are keys to success in your ICD10 conversaion and implementation!  With ICD-10 being implemented this week, are you ready?  Here we go!

  1. Provide ongoing education and re-education for coders. ICD-10 has 68,000 diagnostic codes compared with 13,000 for ICD-9. Even coders with decades of experience are in many ways ‘beginners’ with ICD-10. Initial training will give them the knowledge to start coding in ICD-10, but only hands-on experience and educational feedback will give them the expertise to reach pre-implementation levels of productivity and accuracy.”
  2. Conduct proactive coding audits and assessments. Don’t wait until you start to get coding denials before you audit your coders. It’s important to proactively identify errors and take steps to correct them as they occur.
  3. Increase hiring of inexperienced coders. Traditionally, we’ve been hesitant to hire coders who have completed their education but have no previous experience. Take advantage of the training programs already in place for ICD-10 to recruit coders without real world experience, train them and move them along a career ladder that will build loyalty and reduce turnover.
  4. Evaluate procedures for professional fee coding. With ICD-9, physicians and other professionals at Cedars-Sinai were responsible for entering the diagnostic codes for the services they rendered. We are looking at the commitment required of physicians to learn the new ICD-10 coding system to decide whether that’s the best use of their resources. First and foremost, we want our physicians to be focused on providing patient care. The medical center is exploring the possibility of using coders to do pro-fee coding and training physicians and other professionals in how best to document patient care so as to facilitate accurate coding.

Be sure to contact iData for your direct or supplemental medical documentation needs.  Whether you need coders, transcription, back-office support, or catastrophe planning, be sure to contact iData!

Solution For Your Discharged Not Final Billed Rates!

Supplemental Discharge Summary Report Services
Healthcare leaders who know their financial data points understand there’s one business metric that should never be on the upswing: discharged not final billed (DNFB). If an organization’s bills don’t leave the front door, its cash flow and opportunities to earn interest certainly will.Hospital executives must set acceptable DNFB standards that are consistent in their measurement and organizational-specific issues. So, what can make DNFB rise?

  • Lack of qualified coders (now more than ever with ICD-10)
  • Bills held up for reviews and audits
  • Poor internal review systems between the departments that code records and the clinicians who complete pathology and operative reports.
Most organizations set a three-day threshold for accounts meaning that accounts that are not coded or dropped within three days of discharge appear on the DNFB. Other organizations choose to keep the DNFB at a percentage of overall revenue (e.g. 5%) as their measurement.Hospitals should choose the measure that best fits the organization and stick with it.

Urge collaboration

“Also, develop a collaborative team within the organization that includes representatives from HIM, coding, quality assurance, and others that meets on a regular basis to discuss ongoing issues. In the beginning, this group may meet weekly, and then taper off to a monthly meeting once improvement is seen. In the end, assign the responsibility of the DNFB monitoring to one individual and ensure that they have the tools and resources to review the report, identify process issues, and make corrections.”

In most situations, the CEO or CFO has the HIM director deliver the DNFB rates. Ultimately, the HIM director should lead the effort to improve DNFB rates and should work with representatives from across many groups:  business office, coding, charge-master, admitting, case management or utilization review, quality management, and HIM.

Successfully monitoring and controlling DNFB lies within understanding its cause, says Darice M. Grzybowski, MA, RHIA, FAHIMA, founder and president of HIMentors, LLC, in Westchester, IL.

A HIM department may struggle with getting records coded, Grzybowski says, while other times it may attempt to code the medical record, but find that key information such as a pathology report or dictated operative report is missing.

Success keys
“In some cases, the record is outstanding due to other reasons, such as a problem with a duplicate account number, or there is a question regarding a charge error,” Grzybowski adds. “Whatever the reason, it should be classified in a category and not lumped together for one sum number. The HIM department should work in conjunction with the business office to agree on a method of classifying, tracking, and reporting this data on a regular basis”.How else can healthcare leaders ensure their DNFB rates improve? Grzybowski says leaders can start by:

  • Investing in an HIM operational assessment to identify causes of DNFB and possible solutions
  • Putting an ongoing tracking mechanism in place to monitor DNFB
  • Ensuring the Patient Financial Services (PFS) department and HIM teams agree how DNFB will be defined and measured
  • Enforcing record-completion policies
  • Ensuring that deficiency analysis takes place before coding (within the first 24 hours post discharge) to identify missing data earlier in the life-cycle of record processing, and to improve coder productivity to avoid them spending time searching for missing information
“Those facilities that have undergone a thorough HIM and Revenue Cycle operational assessment can identify the areas that need improvement,” Grzybowski adds. “And by implementing various changes in process, adjusting staffing, or providing better analytical tracking of the DNFB, problems can be avoided with the proper solutions.”
Staffing and technology

Be aware that a shortage of qualified, credentialed, and experienced coders can make your organization’s DNFB rise. A lack of an adequate staff working seven days a week in the scanning, analysis, and coding areas could mean higher rates, Grzybowski warns.

“ICD-10 will most probably make that shortage more severe and have a detrimental effect on DNFB,” she says. “Electronic health records and a good electronic document management system that makes physician completion of record deficiencies easier to manage actually helps improve and decrease the DNFB rate.”

Solution Space

iData provides exactly what you need to substantially reduce DNFB rates at your facility. We understand the task workflow for DSR needs identification, connectivity, DSR completion, quality control, and completion. Generally, the following soon-to-be-patented work flow needed to help your organization includes:
1)    The hospital must give EHR access (ADT, EMR demographics, MR or Episodic #s, etc.) to the complete inpatient medical record (security agreements, BAA, unique access for each physician dictator, etc.).
2)    The hospital would need to identify the records that need to have discharge summaries dictated:
  • Create a queue/ work-list
  • Responsible/attending physician would need to be specified.  This will be the physician who has to eventually sign off on the discharge summary document.
  • Defined time-frame (i.e., day of discharge, day after discharge, etc.)
3)    iData physicians review the inpatient medical record and dictates the discharge summary report.
  • Identifies any issues or need for clarification (i.e., conflicts, specificity, missing/incorrect info, query opportunities)
4)    iData transcribes the discharge summary document and returns it to the hospital for authentication/signature by the responsible physician.
  • Discharge summary report now available in EHR in draft (unsigned) status
5)    Responsible physician reviews discharge summary
  • Any issues/discrepancies -> report sent back to iData to be addressed
  • No issues/discrepancies -> report signed by physician and finalized in HER
Call iData today to help you with Discharge Summaries Reports, reduce your DNFB rates, increase your top line revenues and cash flows – all in a tightening health care market.

Part 3 – ICD-10 is now down the stretch… now what does your practice do?

Part 3 – ICD-10 is now down the stretch… now what does your practice do?

Continuing with our Series about what medical practices and hospitals should be doing now that we are slowly running out of time to design and implement an ICD-10 compliance strategy.  For other Parts in this series, please refer to related blogs.

5. Master the codes that matter
While many physicians have memorized the codes they use in ICD-9, which is harder to do in ICD-10, because the system is more elaborate. Instead, experts recommend focusing on learning the codes relevant to your specialty, rather than all 155,000 codes. “Make a short list of the codes you have to be good at,” says Lance. Place the list for you, your team members, and other staff all over your practice. Until ICD-10 takes hold, challenge each other with ICD-9 to ICD-10 conversion codes quizzes – “Hey, if I have an ICD-9 code for X, what is the ICD-10 up-code or equivalent?”

For practices and specialties that have complicated coding, use a medical documentation service like iData’s coding process – coding expertise using a mature coding workflow that is topped with a sprinkle of subject matter expertise.

6. Diminishing efficiency and productivity

Be prepared for changes to your coding affecting other aspects of your practice’s operations—and divert resources, dollars, and staffers from other tasks and budget items. Look at where your workflow is going to have to change. ICD-10 is no longer about an “if”; rather it is about a “when” and the sooner your practice gets ready and is positioned well at the starting gate, the less impact to productivity (and commensurate revenue) you will experience.

Consider that many taken-for-granted task such as referrals, supply orders, equipment and service orders that were handled within the ICD-9 world, will now need to contemplate how they are created and generated in the ICD-10 world. Be sure that your entire workflow has contemplated the wide-ranging effects of ICD-10.
7. Quality, quality, quality

Every practice should have a point person assigned to regularly check coding to make sure there are no errors that are costing the practice money—and identify staffers who need more training, say experts. The stakes are high for practices that don’t get it right because errors may lead to delayed or denied claims.
No practice can afford to make big mistakes that affect cash flow today, especially in the financially and regulatory tightened and rapidly changing medical field.

Whether small, up-and-coming- or large practice, or if you are the HIM or CIO or a local or large hospital, contact iData to assist you with resourcing a team of expert ICD-10 leaders and coders. iData will readily demonstrate the efficacy of our process, offer free pilot-scale tests, help your transition, and Go Live sooner than you can imagine.