How are Physicians Expected to Bill Post Implementation?

Even though ICD 9 and ICD 10 are very similar in many ways including the guidelines, rules and conventions used which consequently brings out similarity in the organization codes as well; ICD 10 is a product of many improvements done in ICD 9 coding.

In spite of the overwhelming improvements, the transition from ICD 9 to ICD 10 has been a huge challenge for the physicians, medical billers and health care workers to catch up with the advancements. Also the staggering number of new codes has made the learning process a tad complex along with complicating the coding process, making the claims susceptible to errors and vulnerable to denials. This is further exacerbated by difficult denial management.

According to the new proposed rules from Department of Health and Human Services, health care professionals would be required to bill their services using ICD 10, with effect from October 1, 2014. This date has already marked the one year extension to the previous date of October 1, 2013. Along with the introduction on 5010 new electronic codes, the physicians are also expected to meet a few other health and quality information technology initiatives like adopting electronic health records and participating in physician quality reporting system.

With the number of codes skyrocketing from 17,000 to around 140,000, healthcare providers along with their medical billers and coders need to pull up their socks in order to avoid having any problem with insurance reimbursements and denials. According to the official website of CMS, compliance date for implementation of ICD 10 is October 1, 2014 with no grace period or further delay expected, however they have not yet mentioned grace period for billing under ICD-9 without penalty post October 2014.

Nonetheless the transition period would pertain roughly for two years during which the coders would have to work simultaneously with both, ICD 9 and ICD 10. At the same time, the billers would be required to train with new set of procedures and policies, in absence of which the employer might result in lowered productivity in the future. The billers also need to learn about the policies introduced for payment reimbursements along with the new ANSCI reposting methods and electronic formatting procedures.

Medical Billers and Coders with ICD 10 implementation will additionally need to possess a more detailed knowledge of the anatomy, physiology and medical terminology and also work in close association with the doctors and educate them about the proper coding methods.

Also as mentioned earlier with no further delay expected, medical practitioners need to catch up with the new reforms; to avoid as much as possible any chance of decreased cash flow. With a possibility of increasing call volume for denials and rejected claims along with increased billing audits, it is advised that physicians take the next step towards ICD 10 transition soon.

MedicalBillersandCoders.com serving healthcare for more than a decade now have already initiated a unique ICD 10 training program which helps coders and billers get updated with the latest ICD 10 developments and reforms. Our billers and coders are already preparing for this transition as our training program endeavours to positively help you, as a medical coder and biller to remain at your competent best when the times change from ICD 9 to ICD 10.

Gauging your Medical Billing Company on ICD-10 compliant resource-capability

“As much as the intrinsic competencies of your medical billing companies, their ability to advise on EHR/EMR implementation for efficient clinical and operational management  should equally hold prominence. As HIPAA 5010 compliant EHR/EMR is the prerequisite to medical billing under ICD-10 system, your practices needs to be equipped with EHR/EMR that meets HIPPA 5010 standards both as a compliant measure as well as qualifying measure for incentives under Meaningful Use Criterion.”

Physician practices, clinics, and hospitals, who hitherto have been safely entrusting all their billing operations to their respective outsource providers, will soon have to run a reality check of the level of preparedness that their medical billing service providers possess or likely to possess in congruence with the ensuing ICD-10 – going to be operational from October 1, 2013. Although most of the medical billing companies are mindful of the efficacy to be resourceful with ICD-10 medical billing management requisites – as they themselves will not be able to operate with ICD-9 compliant practices, which are soon going to be obsolete – yet it is a kind of reassuring exercise that your medical billing reimbursements are channelized through incredible and safe hands.

Now, having been convinced of the efficacy of running a reality check of either your current or prospective medical billing companies, it is quite natural to be inquisitive of the nature and extent of such reality check. Primarily you need satisfy yourself whether the service provider is self-sufficient in resources – both human as well as technological – that render medical billing management possible in the ICD-10 compliant environment. Notwithstanding other things like credibility in the industry, composition of clients, and experience as a medical billing company, it is this resource capability for ICD-10 compliant medical billing that holds the key to your delay-free and denial-free medical reimbursements of your medical claims for clinical services rendered to the Medicare or private insurance beneficiaries. And, when you consider how vigilant and stringent health insurance carriers are becoming, your medical billing service providers’ ICD-10 compliant competencies assume ever more significance.

When it comes to gauging your medical biller’s human competencies, it is necessary that professionals are trained in ICD-10-CM Implementation Training, ICD-10-CM Anatomy and Pathophysiology, ICD-10-CM Code Set, and ICD-10-CM Specialty Code Set. Further, along with a knowledge background, they need necessarily hold qualifying certificates from authorizing agencies that confer professional certification in ICD-10 compliant billing and coding –  AAPC (American Association for Professional Coders) and American Health Information Management Association (AHIMA) happen to be the competent agencies in the U.S.