Most agree the medical portion of Workers’ Compensation claims is now almost 60% of claim costs. That fact alone should easily convince payers to focus on the rich medical information in their data. Yet, very powerful information residing in claims data is virtually ignored—diagnostic codes in the form of ICD-9’s. The problem is few in the industry really understand ICD-9’s or in what ways they could inform and super-charge medical management.
ICD-9’s on bills are displayed in the form of codes, not descriptions of injuries and illnesses, and they number in the thousands. Individuals cannot remember the codes, nor do they have the time to look up codes for interpretation. Instead, they simply ignore them.
As a claims migrates, the number of ICD-9’s associated with it mounts.
Claim ICD-9 scores are predictors of risk and cost. Claim ICD-9 scores can be monitored from the outset and throughout the course of the claim.
Karen Wolfe is President and CEO of MedMetrics®, LLC, an online Workers’ Compensation analytics company. MedMetrics provides “apps” online that link analytics to operations, thereby making them actionable. MedMetrics also monitors concurrent integrated data, including ICD-9 scores to detect potentially high risk or high cost events occurring in claims. firstname.lastname@example.org