How Aurora Health Care is dual coding for ICD-10

Coders at Aurora Health Care, an integrated health care system of more than 150 clinics and 15 hospitals headquartered in Milwaukee, Wis., were already busy. So finding time to dual code seemed like an impossible hurdle. But administrators knew that the practice was critical to prevent revenue loss in ICD-10.

“The Advisory Board’s initial risk assessment in 2012 indicated our cash flow impact could be as high as an additional 22 A/R days” said Forrest Gallagher, strategic program manager for Aurora. “That gets people’s attention. We’re a $4-billion company, so that’s a lot of additional cash on hand.”

With a clear dual-coding mandate, administrators looked for ways to maximize the investment with minimal resources. And for that, they turned to the Advisory Board. In only two months and three steps, our revenue cycle experts helped Aurora realize this goal. Here's how. 

Step 1: Identify high-impact DRGs for dual coding

Like most providers, Aurora didn’t have unlimited resources to devote to dual coding. It would have been impossible to dual code every claim, and Gallagher stressed that the system didn’t want to overwhelm its coders before ICD-10 took effect.

To maximize ROI and save coders from burnout, we recommended limiting dual coding to DRGs with high risk of revenue loss in ICD-10. Our experts looked at revenue and historical claims volume and chose 100 DRG groupings at the highest risk. Within these groupings, they then chose a subset of claims that covered all Aurora's facilities and major payers.

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This prioritization allowed Aurora to mitigate the vast majority of inpatient and outpatient revenue risk while only dual coding 9% of claims in high-priority areas.

Step 2: Create a phased implementation plan

Even with effective prioritization of claims, coders need time to master ICD-10 requirements. So we recommended Aurora roll out dual coding in stages.

The Advisory Board gave us a cookbook. We just need to follow the recipe.”

Each phase of Aurora's four-phase plan will last three months and expand the total number of DRGs and diagnosis codes eligible for dual coding. In phase one, inpatient coders will receive only a handful of claims per week to dual code. By phase four, they will be expected to code about four times as many.

This clear, timed implementation plan has taken some of the pressure off Aurora's administrators. “The Advisory Board gave us a cookbook. We just need to follow the recipe,” Gallagher said.

Step 3: Establish feedback loops

Administrators at Aurora will conduct periodic audits of their ICD-10 coding accuracy and use the results to inform training plans for physicians in high-risk specialties. Aurora’s ICD-10 project team will also use our analytics platform to understand expected revenue shifts and work with revenue cycle and payer relations colleagues to prepare.

Aurora's investment will save time and headaches in the long run.

“It’s so important to get a handle on what the financial impact [of ICD-10] is going to be. Dual coding is a worthwhile effort,” Gallagher said.

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