News

First story

Impact of ICD10 on providers

ICD-10-CM will affect both physi­cian and hos­pi­tal ser­vices whereas ICD-10-PCS will only affect report­ing of hos­pi­tal inpa­tient services.

Sim­i­lar to pay­ers, physi­cian prac­tices will need to make sys­tem mod­i­fi­ca­tions or enhance­ments. Hos­pi­tal Infor­ma­tion Sys­tems (HIS) and Prac­tice Man­age­ment Sys­tems (PMS) will be affected as well as EHRs. In addi­tion, other sys­tems such as patient sched­ul­ing, may imbed ICD through­out the pro­cess­ing logic. To fully under­stand the impact of required sys­tem changes, health care providers should per­form a com­plete sys­tem assessment.

Providers should inter­view ven­dors whose sys­tems have ICD impacts to deter­mine their readi­ness. Ven­dors who do busi­ness inter­na­tion­ally may already accom­mo­date ICD-10. Other ven­dors may have plans to upgrade sys­tems by the com­pli­ance date. A third group of ven­dors may not have plans to upgrade due to the age of the sys­tem or tech­nol­ogy. For sys­tems that fall into the lat­ter cat­e­gory, an alter­na­tive tech­ni­cal solu­tion must be sought. The ven­dor selec­tion process and imple­men­ta­tion of a new sys­tem can take time, mak­ing the ini­tial sys­tem assess­ment an impor­tant task to per­form early in the process.

Addi­tional sys­tem impacts include:

  • Imple­ment­ing new tech­nol­ogy to assist with code assign­ment because of the large num­ber of ICD-10 codes
  • Main­tain­ing both ICD-9 and ICD-10 for a period depend­ing on the needs of the indi­vid­ual practice
  • The abil­ity to resub­mit an increased num­ber of denied claims due to errors on both the payer and provider side

Health care provider work­flow may change to accom­mo­date new tech­nol­ogy. Doc­u­men­ta­tion such as physi­cian prac­tice “super­bills” which list diag­no­sis and pro­ce­dures rou­tinely used to treat patients in that prac­tice will require changes to sup­port the new cod­ing structure.

Due to the cod­ing, sys­tem, and process changes, train­ing of health care provider staff mem­bers is crit­i­cal. Clin­i­cians will require train­ing to improve doc­u­men­ta­tion to reflect com­plete and detailed descrip­tions of med­ical con­di­tions and ser­vices. This will allow the cod­ing staff to code for med­ical records and claims sub­mis­sion accurately.

Because of the com­plex­ity of the new cod­ing sys­tem and poten­tial imple­men­ta­tion of new tech­nol­ogy, now is a good time to assess the skills of staff mem­bers. It may be nec­es­sary to develop skills in dis­ease pathol­ogy or phar­ma­col­ogy, anatomy and phys­i­ol­ogy, and com­puter skills.

Health care providers may expe­ri­ence a decrease in staff’s pro­duc­tiv­ity due to train­ing, learn­ing curve of tran­si­tion­ing to the new cod­ing sys­tem and new tech­nol­ogy, and repro­cess­ing denied claims. Because of this impact, exist­ing staff may need to work extra hours or tem­po­rary staff may be required to main­tain cur­rently work­load while per­ma­nent staff is trained.

 

 


Sec­ond Story

Key advan­tages of med­ical cod­ing:

Med­ical cod­ing is a grow­ing health­care pro­fes­sion­al­ism which has started to receive a lot of focus and atten­tion from the med­ical health indus­try today. Med­ical coders are highly essen­tial in the med­ical indus­try because they are the ones whom will be apply­ing the appro­pri­ate code to the ser­vices, treat­ments, pro­ce­dures and exam­i­na­tions con­ducted. These codes are very impor­tant infor­ma­tion as they need to be very pre­cise and accu­rately sent to the insur­ance com­pa­nies to get the nec­es­sary pay­ments for those ser­vices which they have pro­vided to their patients.

Next, let us get our­selves indulged into the med­ical cod­ing world by learn­ing every­thing about med­ical cod­ing and also to weigh some of their key advan­tages to the soci­ety today.

Here comes some of the key advan­tages of cod­ing ser­vices and how they have helped in expand­ing and enhanc­ing this med­ical pro­fes­sion in and bring its key val­ues to be well acknowl­edged glob­ally at the same time;

1. Med­ical coders can work in a vari­ety of set­tings, right from the doc­tors’ offices, hos­pi­tals, med­ical cen­ters, law firms, insur­ance agen­cies and many more. This had opened up a wide range of job oppor­tu­ni­ties for med­ical coders whose spe­cialty is not con­fined to hos­pi­tals or clin­ics only.

2. Med­ical coder is a new pro­fes­sion in the world of med­ical health which is grow­ing steadily with increased demand of at least 15% annu­ally over across world-wide. The demand for qual­i­fied med­ical coders are extremely good in the job mar­ket today and no one with an accred­ited degree or cer­tifi­cate should worry about their career path because most of these med­ical cod­ing stu­dents tend to suc­cess­fully get their “employ­ment” with the local hos­pi­tals, pri­vate spe­cial­ist cen­ters or insur­ance com­pa­nies even before they actu­ally grad­u­ated from the uni­ver­si­ties or school.

3. Some med­ical coders are allowed to be work­ing from home from their employ­ers. While not all employ­ers pro­vide such priv­i­lege to their employ­ees, those that does will tend to attract those who are with equipped med­ical cod­ing exper­tise but due to fam­ily issues, they can­not accept any med­ical cod­ing related job which need them to be away from their home due to some­one will need to take care of their old folks or young dependents.

4. Start­ing off with your ground on med­ical cod­ing espe­cially for those with a col­lege degree, one has great room and oppor­tu­ni­ties for fur­ther advance­ment of his or her career choos­ing to spe­cial­ize in any of these areas, such as chi­ro­prac­tic, car­di­ol­ogy, or any other defined areas. With the cer­ti­fi­ca­tions awarded from theAm­er­i­canAcad­e­myof pro­fes­sional coders, you will be on high grounds aim­ing for your career goal with great recog­ni­tion and achievements.

5. One of the most impor­tant rea­son why med­ical cod­ing exist and in fact has been widely rec­og­nized for its ben­e­fits today is because with this “error free” med­ical cod­ing sys­tem, med­ical billing pro­ce­dure get to be imple­mented smoothly and per­fectly. Med­ical cod­ing sys­tem is an inte­gral part of a gen­uine med­ical billing prac­tice because it had enabled the pay check for doc­tors, nurses and many other med­ical per­son­nel to be issued timely and accu­rately. With the high integrity of spe­cial­ized cod­ing incor­po­rated into the med­ical reim­burse­ment process, we hope that insur­ance com­pa­nies will be pay­ing out the nec­es­sary insured val­ues to the respec­tive med­ical cen­ters, hos­pi­tals, clin­ics or nurs­ing houses as effi­cient as possible.

I would like to point out 10 Steps for Effi­cient Med­ical Elec­tronic Billing
Claims Submission:

(1)        Assum­ing you have the Med­ical Billing Sys­tem in your office, next step is to
sign up with a clear­ing­house with a rea­son­able monthly flat fee regard­less how many
and how much claims you can sub­mit and resub­mit. Make sure you do not pay any
other fees on top of the flat fee. The clear­ing house must be fully com­pli­ant with
HIPAA. There are many avail­able ven­dors out there. You can sub­mit claims through
web-based solu­tion or through a modem directly you’re your com­puter. I will talk
about this on the later part of this article.

(2)        Make sure you have all the list of pay­ors’ num­ber with the insur­ances you bill
and par­tic­i­pate with. This payor num­ber will iden­tify where your claims will go based

on the patient’s insur­ance infor­ma­tion. Your tax num­ber should also be in your billing
system

(3)        By enter­ing your patient’s infor­ma­tion. One infor­ma­tion that you have to be
care­ful is the patient’s insur­ance ID num­ber. I strongly sug­gest to input the num­ber
as is with­out any other char­ac­ters other than alphanu­meric char­ac­ters. In other
words, avoid using an aster­isk and dashes on this field.

(4)        Make sure you have obtained prior autho­riza­tion or you have ver­i­fied
cov­er­age for the patient for that date of service

(5)        Avoid using out­dated ICD and CPT codes. Make sure your diag­no­sis codes
(pri­mary or sec­ondary or ter­tiary) does not require a 5th digit.

(6)        Make sure you use proper mod­i­fiers. Nowa­days, elec­tronic billing sys­tems
are intel­li­gent enough to pick up errors. Nor­mally non-numeric mod­i­fiers are always
in big letters

(7)        When you cre­ate the file, you have the option to pre­view all the claims.
Before you sub­mit this file elec­tron­i­cally, make sure to check for miss­ing infor­ma­tion.
Edit the claims for errors. Finally sub­mit your file.

(8)        Gen­er­ate reports after you sub­mit the claims. Make sure all claims are said
to be “accepted”. If you see rea­son code as “rejected”— imme­di­ately cor­rect the
claim, call the insur­ance and resub­mit the claim. Always read all your elec­tronic
trans­mis­sion receipts/reports!

(9)        Keep track of your claims. A med­ical billing soft­ware with a tracer tool is a
very pow­er­ful sys­tem. As you can track your pending/waiting and unpaid claims.
Per­sis­tent fol­low ups for pre­vi­ously denied and rejected claims is a must.

(10)        Last but not the least, gen­er­ate a report to rec­on­cile bills to appoint­ments.
This way you know which appoint­ment dates was not billed and no super­bills was
generated.

If you want to elim­i­nate all the above work plus the headache and aggra­va­tion for
claims rejec­tions, denied and under­pay­ments, the best way is to out­source your
billing needs to an expe­ri­enced full ser­vice med­ical billing ser­vice com­pany. This
way, it also saves you all other admin­is­tra­tive and man­power over­head expenses.
Make sure you con­sider a com­pany that spe­cial­ize your area of spe­cialty and who
knows your busi­ness. Mak­ing this choice and the deci­sion is very crit­i­cal to your
prac­tice as this billing ser­vice becomes your back­bone for revenues.