You've probably heard by now that the required switch to using ICD-10 has been delayed by a few years until October 2013. You can breathe a little easier for now, but have you begun to consider how your office will implement the changes? And what do these changes mean to you anyway?

A little background...as you know, insurance companies do not pay for "tension headaches" and "15 minute office visits for an established patient" - insurance companies pay for medical diagnosis codes like 307.81 and procedure CPT codes such as 99213. Diagnosis codes, CPT and HCPCS codes all describe patient complaints, illness, procedures and supplies for a submitted claim. The ICD-9 codes currently in use were adopted in the 1960s by the U.S. Since then there have been many advances in healthcare. Under the current coding system, the room to expand is limited. By adding codes under the new system, there will be room to expand and be more specific in reporting.

How much so? Think there are a lot of codes now? Try 68,000 diagnoses codes, up from 13,000 now. For procedure codes (CPT) we go from 3000 codes now to 87,000 codes! What's more, ICD-9 codes will go from up to 5 digits (ex. 307.81) to up to 7.

The deadline for implementation is 2013, which is still in the future. According to a recent article in the Wall Street Journal: "CMS says it expects implementation of the new system initially will boost by as much as 10% the number of claims returned because of coding errors. But a study by the Blue Cross and Blue Shield Association of insurers predicts billing errors are likely to rise between 10% and 25% in the first year."

If you currently do your billing in-house and file using on-site software, the switch to ICD-10 could be a large expense for updates to your software as well. What's more, by January 1, 2012 all physicians must begin using the new version of HIPAA transaction standards known as 5010 in order to file claims. This is due to the fact that the current 4010 version does not accommodate ICD-10 codes. Even if you believe you can put off updates to switching to ICD-10, you should at the very least start considering what it will take to update to the 5010 transaction standards.

It may be a good time to consider either a switch to outsourcing your billing to pass the cost off to a billing company, or at least consider an internet based billing program. The advantages with internet based electronic claims filing is that the updates are built in to the platform at no cost to you other than your regular fee of using the service. This could potentially save you thousands upfront as well as over the long run. The whole purpose of the switch to ICD-10 is to accommodate the annual updates in technology and procedures. You can be sure that any in-house software you use for claims filing will require annual updates that can represent cost to you as well.

You can see why it will be more important then ever to have a coder educated on the new codes as a part of your practice. Implementation of the new system will be costly, so when the time comes, out-sourcing your coding could be a cost-saving solution.

Labels: electronic claims filing, icd-10, medical coding

Outsourcing can seem like a touchy subject and you might even feel like it is a cost. But when you step back and take a look at what it costs your practice to run all of the operations yourself, that can be a cost as well, even though it may be hard to put a dollar value to it.

Billing is the most important aspect of any practice. Yet sometimes billing becomes an afterthought. Scheduling patients, pulling charts, answering phones...you get the picture. Everything that happens on a day to day basis can cause paperwork to be pushed to the side to be taken care of later. This can be a cost to you when this happens with your billing. Timely filing rules with insurance carriers, the cost of floating money that could be in your bank account, that is a cost. A professional medical billing company is a specialist whose sole responsibility is keeping your cashflow positive.

Think about the technology cost aspects of billing as well. With the ever changing nature of medical billing, there can be a significant cost to your practice as well. Software purchases and updates, compliance systems...these can add up. When you outsource your billing, you pass the cost of technology off to the billing company who is able to spread their cost across several practices.

How about everyone's favorite task? Following up on insurance denials. In many practices that I speak with, this is one of the last things to get attention. It is time consuming, it can be frustrating and confusing, and as a result denials can slip through the cracks. It is not uncommon these days for a practice to have 30% or more of their claims denied. A lot of that just gets written off. Why? Insurance carriers are constantly changing rules. Visit Medicare's website...ever try to find why your claim denied by searching the CMS website for that one specific nugget of information? If you could put a dollar value to the cost to your practice just for denials and all of the follow up involved, what do you think that would be worth?

A professional medical billing company does all of that work for you. Better yet, a billing company that works on a contingency basis ( charging a percentage of monies collected ) has more of an incentive to collect your money than an office staffer paid by the hour.

Many physicians code their own charts as well. This can be very time-consuming, preventing you from scheduling and seeing more patients. Errors can occur as well, even if you use software. Coding programs don't always get updated resulting in incorrect coding of claims. As of October 2013, healthcare providers will be required to be using ICD-10 codes. How much more time consuming will that be when diagnosis codes go from around 17,000 to 150,000? Outsourcing coding may seem like a cost, but there is a dollar value to the work you do as well. What pays you more? Doing work that someone making $10, $15, $20 per hour can do ( coding ) or seeing patients?

For more information on why it benefits doctors to outsource systems that can be done at a lower cost by others, read this article from BC Advantage, "Why Doctors Should Outsource Their Billing."

Labels: medical billing, medical coding, outsource medical billing