The top 4 medical coding tools!

April 8, 2015 by Ango Mark Leave a Comment

It can be incredibly frustrating and laborious to assign medical codes. The complexity of the medical coding process has increased manifold due to the latest healthcare reforms. There is demand for perfect documentation. Anything less than perfect, means, rejected claims, or, worse still, fines for miscoding.

Automate: The sooner the better!

There has to be a better way to code. Right? Well here is the solution, automate. Using tools to code can help in streamlining and quickening the medical coding process.

4 super-efficient medical coding tools!

1.Turbo Coder:

Turbo Coder is a digital coding tool that is user friendly. This tool includes ICD-9CM, ICD-10CM, HCPCS and CPT codes. The Turbo coder has truckloads of smart features such as, pre-emptive search spelling help, spell checker, main term search, annotation and notes, multi screen view where you can view four sections at the same time. And the most important feature, security! Turbo Coder is an excellent adjunct tool that helps with coding visits. This digital coding software has indexed digital content as well.

2.TruCode:

It is a feature rich tool that helps to eliminate claim denials, due to coding errors. TruCode promotes coding accuracy. It automatically presents critical coding information within a single encoding screen. TruCode helps in bettering coding outcomes.It has a neat interface and is easily navigable.

3.3M™

Improve the quality of your clinical documentation with the 3M™ tool. This 3M™ tool enables accurate coding and streamlines the outpatient and inpatient coding process. Maintaining quality metrics and achieving appropriate reimbursement for services is easier with this software. 3M™ coding tools helps in adding greater specificity and accuracy to coded data.

4. BillingBridge

Want to know what your top paying codes are? Know what works! BillingBridge is a code analytics app that helps users to view their top performing CPT codes, most used codes and frequently made coding errors. It helps medical coders to make course corrections and systematizes the medical coding process. It has an uncluttered interface and informative dashboards. Inbuilt query tracking and chat support is also available.

Stop denials to a large extent with the help of these smart coding tools!

ICD10 costs are a whole lot higher than expected! Will physicians be ready by October?

February 20, 2014 by Ango Mark Leave a Comment

Eyes to the skies! ICD-10 costs are skyrocketing!

The titters have died down! Forget those jokes about walking into a lamppost and macaw bites. ICD-10 is going to bite medical practices much harder. With the deadline for implementing ICD-10 looming closer. It is time for medical practices to do more than just wait for the next pushback announcement.

As every day, news trickles about the cost of implementation and the impending deadline, physicians are shaking in their boots. But there is little hope for another deadline shift.

The shocking increase in costs over the last four years!

The approximate cost for implementing ICD-10 in 2008 was $83290. Four years down the lane the costs have escalated to $226,105.

Medium sized practices are going to feel the pinch as well; from costs estimated to be 285,195 in 2008 it has now skyrocketed to 824,735. And the costs are going to be as much as 8 million dollars for large sized medical practices.

The costs come as a sticker shock for medical practices that are still reeling under the pressure of accommodating the enormity and breadth of ICD-10. Medical coders who were using a coding system for several years are now faced with the challenge of working with codes that are absolutely foreign to them.

Though people on the other side of the wagon argue that greater specificity can help researchers and increase reimbursements, long term pay offs mean short term losses.

It is not going to be an easy transition…

Well almost everybody knew it! Right from the day ICD-10 was announced there have been voices of dissent. But as the deadline draws near it is clear that physicians have been caught off guard. It is going to change the workflow of medical practices and medical practitioners are justifiably, freaked out.

Still don’t have an ICD-10 coder?

Practices cannot afford to bill without a trained coder. Hiring novices means struggling under a deluge of rejected medical claims. An increasing number of medical practices are thinking of hiring virtual coders. Or, fall back on the time tested solution of outsourcing.

It is the hour of reckoning and practices should either ramp up their implementation process or stay behind. Complaining about the costs is not going to help physicians. Trying, to find ways to protect their revenue stream, and, investing in the new coding system, will.

Rest Assured – Coding Howlers in Oncology Practice are Removable

September 23, 2013 by Ango Mark Leave a Comment

Oncology is a clinically-focused specialty that is undergoing frequent technological and process updates. It requires a high degree of physician’s skill, experience and the urge to learn to stay tuned with the revisions related to documentation, coding, billing, and revenue cycle management (RCM).

Common Oncology-Specific Coding Errors :

Errors abound. Some of the many are:

1. Coders are not up-to-date with on-going changes in codes and related modifiers.
2. Failure to capture correct levels of CPT (Common Procedural Terminology) codes.
3. Under-coding and over-coding errors.
4. Misusing modifiers, using of wrong modifier and mixing up of modifiers.
5. Coders are not conversant with coding for specialist oncology services such as bone marrow procedures, transplantations, and blood transfusions.
6. Coders round off drug administration times instead of noting the exact time.

What the Experts Have to Say :

According to oncologists, correct coding is the main ingredient for successful practice. The complexity and regular updating of coding system contribute to unintended coding errors. According to the American Society of Clinical Oncology (ASCO), failure to complete the code capture at the time when oncology procedures are provided is common.

Continued usage of codes that have been eliminated by Medicare continues to be the bane of the US oncologists. A survey conducted by two nationally recognized experts in oncology practice management-Roberta Buell from OnPoint Oncology LLC and Patrica Falconer from Health Options, on behalf of the Association of Northern California Oncologists (ANCO), revealed that only 1 out of the 14 surveyed practices had updated their oncologists about the elimination of consultation codes by Medicare.

According to Cynthia Stewart, coding education coordinator president of AAPC, problems arise for coders when physicians fail to document the steps they went through to arrive at a diagnosis. Enos further clarifies that coders need to understand the depth or extent of medical decision making. Medical decision depends on complete documentation to make a “medical necessity linkage” between the procedure performed and the diagnosis code.

Tips to Ensure Correct Coding :

There are umpteen of them – to name a few :

1. Be aware of on-going changes in codes and modifiers.
2. Continually train oncologists and coders on coding mistakes and consequences, along with how to avoid the mistakes.
3. Do not neglect equipment or instrument used : Be conversant with recent codes related to the equipment or instrument (e.g. for radiation oncology) used to provide oncology services.
4. Beware of the tendency to code according to the complexity of the diagnosis, rather than the extent of decision making involved.
5. Be aware of new or established (existing) office visit codes and in-patient visit codes established by Centres for Medicare and Medicaid Services (CMS).
6. Make sure you understand the billing rules and regulations for Medicare and private payers. In fact, with the high cost of new cancer therapies, many oncology practices are now verifying insurance information before every treatment.
7. The American Medical Association’s (AMA) multi-specialty Relative-Value Update Committee (RUC) frequently reviews and updates oncology codes. Keep in sync with these changes.
8. Oncology clinics and hospitals will find the guidebook on billing and coding for oncology-related services offered by American Society of Clinical Oncology (ACCO) very useful.

Escapade from the Oncology Coding Malaise :

Perplexed and unsettled due to plethora of oncological coding errors! Don’t panic. Be assured by adopting a prudent approach by outsourcing or rather “Right Sourcing” your coding worries to MedicalBillingStar,as we :

A. Are an established, experienced, and knowledgeable one-shop outsourcing vendor for oncology coding in the US.
B. Are conversant with intricacies of oncology coding practices and comply with medical coding systems such as International Classification of Diseases (ICD), Current Procedure Technology (CPT), and Healthcare Common Procedure Coding System (HCPCS).
C.Understand your EMR and work with any platform, with security features and options. You are free to select EMR/EHR of your choice and we will cover the involved expenses.

Here’s our presentation on 8 Oncology Coding Tips !

The Hallmark Solutions To Frequent Medical Coding Gaffes

September 11, 2013 by Ango Mark Leave a Comment

Most healthcare providers are on the horns of dilemma due to the medical coding mistakes and the ensuing claim denials. The Best Medical Coding Practice paves the Greenway to recoup your dollars for the exact service rendered by you, whilst improper coding takes away your dollars. This article underscores the common coding mistakes and the conduit to resolve them.

Ensure Medical Necessity :

The healthcare insurance payers are progressively more apprehensive about the medical necessity. The payment for the physician services is based on the CPT codes, whereas the claim approval and reimbursement by the payer is based on the diagnostic codes. Thus, elucidating the harmony between CPT and diagnostic codes is a key step in the coding process. If the payer deems that the service is medically necessary, you will be paid or else your repayment will be hampered and/ or even you will be monetarily penalized.

Ethically Exploit the Modifiers :

A Modifier is the Nucleus of Multi-procedure Coding-based medical claim. Modifiers can be the benchmark for full reimbursement – abridged reimbursement – complete denial – or partial denial. Forgetting, abusing or confusing modifiers in requisite circumstances may lead to negative impacts on reimbursements.

Examples :

1. Failure to tag on Modifier 25 to the E&M service or erroneously appending it to the surgical procedure will cause claim denial.
2. A CPT code linked with Modifier 51 notifies the payer that two or more procedures are being done on the same day and to employ the multiple procedure payment formula. Modifier 59 tells that the procedures/services those are not usually reported collectively, but are apt under a specific circumstance.
3. CPT advocates using Modifier 24 with an “unrelated E&M service by the same physician during a postoperative period.”
4. Modifier 53 is tagged on, when the physician opts for ceasing a surgical or diagnostic procedure because of extenuating events or a hazard to the patient’s health.

Shun Missed Charges :

Most biggies among healthcare providers, can simply fail to spot charge captures for the multiple services delivered. Imaging, laboratory and other subsidiary services often miss the unwritten/ verbal orders of the clinic or lab staff. Better avoid or document the ‘verbally communicated orders’ so as to rule out this problem.

Take Cognizance of the Code Revisions :

Many providers use out-of-date encounter forms thinking that updating is an onerous and mind-numbing task. But, it is inevitable to update the Superbills with the revised codes so as to recoup your payment for the rendered service. Every year, procure new CPT, HCPCS and ICD-9 books and educate the pertinent staff members to get accustomed with the revised codes.

Eschew ‘Over-coding’ and ‘Under-coding’ :

Over-coding is sometimes deliberately done to acquire a higher reimbursements, but it may lead to claim denial and often resubmission or appeal processing/ penalty cost more than that of the anticipated payment.
Example: If, the code 413.9 (unspecified angina pectoris) is used along with 414.01 (Coronary atherosclerosis of native coronary artery), instead of 414.01 alone, it is ‘over-coding’ and would be considered as a fraudulent activity by the corresponding statutory authorities.

Under-coding is usually a result of ‘fear for denials’. The best solution is to do ethical coding using coding and quality control veterans. Besides, perform NCCI (National Correct Coding Initiative) or other appropriate edits to ensure correct coding and to control the inappropriate assignment of codes that result in improper reimbursement or penalty.
Example: Some physicians consider 99213 as the default code as they believe much documentation will be desired for coding anything higher and they deem 99213 is the safe and sound option. But, in point of fact, this is an under-coding and culminates in diminished reimbursement.

The Soul of Medical Coding Remedies :

In a nutshell, our think tanks say that the following tips can augment accurate coding, and sequentially, medical practice revenue vanished to denials:

1. Keep your staff abreast of the revised codes.
2. Educate your staff to hone their coding skills.
3. Create a channelized workflow between coders and physicians.
4. Follow ethical coding practice.
5. Resubmit denials earlier and rigorously track the denied claims.

Click here to have a word with MedicalBillingStar and crash the coding menace effortlessly !

7 Salubrious Coding Tactics to Thwart Claim Denials

August 28, 2013 by Ango Mark Leave a Comment

Evolving code sets in varied coding systems (ICD-10-CM/PCS, CPT-4, HCPCS Level II, etc.) are creating an intricate, but beneficial platform for the patient care, clinical documentation, data transfer, research, practice analysis and also repayment. Despite this pragmatism, quite a lot of physicians don’t recognize the significance of coding in clinical practice and its impact on reimbursement.

The Tactics to Beat Around the Bush :

Beyond a shadow of a doubt, coding is the backbone of the practice business. Improper medical coding cause claim denialsand culminate ultimately in revenue loss. Thus, it is imperative to address the hardships in medical coding with a fresh pair of eyes.

1. Update to Upsurge : Once the new codes are released, every practice must update their encounter forms, super bills, user guidelines and EHR/PMS systems with the fresh codes to create clean claims and to zero down the denials.

2. Revise to Revive : During every ‘updated codes’ release, revise the corresponding fee schedule up-to-date, so as to improve your bottom line and to achieve compliance.

3. Educate to Excel : Apart from updating the tools and systems, it is indispensable to educate the physician and the coders with the fresh and revised codes and the records desirable to make the codes evident.

4. Check to Cheer: Although, the claim scrubbers effectively validate claims – by recognizing billing errors and creating edits to scrutinize denial issues – a manual check could ensure submission of clean claims. For example, the scrubbers may fail to validate the modifiers even though the software flags the claim as “modifier inappropriate”.

5. Review to Revamp : It is essential to review the new payment policies and coding guidelines constantly, to get acquainted with the payer’s regulations.

A. CPT^®: The American Medical Association’s (AMA’s) revised CPT^® codes can be effortlessly recognized. The green text in the CPT^® code book highlights the modifications that are new to the revised book. Sometimes, the guidelines will modify or add supplementary information for proper codes although the codes remain unchanged.

B. NCD/LCD : Medicare’s National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) can be reviewed through the Centers for Medicare and Medicaid Services’ (CMS’) website. More to the point, the revised payment policies of private insurance companies can be reviewed through the payer’s website. Reviewing the policies in this fashion aids the coders to – elucidate code use – spot the diagnoses that call for medical necessity – offer documentation requirements.

C. NCCI : The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services can be reviewed to understand the bundling of codes. Supplementations and revisions to the policy manual have been italicized in red font in the electronic copy.

6. Designate to Delight : It is unfair that most physicians don’t designate the primary diagnosis among an array of multiple diagnoses performed on the same patient. Furthermore, the physicians must number the diagnoses in the order of their significance so as to evade the denials based on ‘medical necessity’.

7. Invent to Infer : Following the aforesaid steps will assist you thwart claim denials associated with code revisions but will not eradicate them utterly, making “denial resolution” obligatory. All the perfectly created codes would not get you the repayment. For instance, one of the new complex chronic care coordination (CCCC) code – 99488 is not reimbursed by Medicare as per its policy guidelines and thus it will be denied. But, on another edge, a secondary or other insurance payer may reimburse for this code. Thus, you need to invent a procedure so as to deduce the non-covered codes for every payer in your network.

To know more about the coding tactics or to clinch a deal !

Contact MedicalBillingStar @ 1-877-272-1572

Infographics: Wriggling Out Of Problematic Emergency Medicine Coding Nightmares

August 20, 2013 by Ango Mark Leave a Comment

In today’s healthcare scenario,Emergency medicine (EM) practice have assumed enormous importance due to ever-increasing natural as well as man-made disasters, not to speak of acute health problems created by changing lifestyle and fast-spaced competitive environment. Few people appreciate the importance of emergency medical services until they are the ones having an emergency.

The EM Practice Fact Box :

1. Heavy Patient influx !EM services have emerged as the gateway for hospitals, and account for more than 50% of hospital admissions in the US.
2. According to the US Health Directorate, there was a spike in the number of patients who were seen in first 10 minutes (wait time) in 2012 (23.5%)as compared against 2009 (18.62%).
3. Thought-provoking !Every year, around 300,000 persons in the US experience an out-of-hospital cardiac arrest (OHCA), and approximately 92% of these die, according to Centres for Disease Control and Prevention (CDC).
4. Food for Thought !The majority of persons who experience an OHCA event do not receive cardiopulmonary resuscitation (CPR) or other timely interventions.
5. Revenue Potential !According to OIG (Office of Inspector General, US Department of Health & Social Services) between 2001 and 2010, Medicare payments for EM services increased by 48%, from more than $22 billion to more than $33 billion.
6. A surprise ! In a survey of Emergency Medical Services (EMS) leaders in the 200 largest American cities, the Journal of Emergency Medical Services found that 44 % of the areas surveyed had made budget cuts to emergency response services in 2012.

Against this back drop, it is not surprising that overworked EM physicians are unable to keep abreast of the constantly evolving and changing clinical codes and related modifiers. This situation is further aggravated due to impeding implementation of ICD-10 and the spate of on-going EM inventions and enhancements. The ever-shrinking reimbursement pool in EM forces every emergency clinic to focus on revenue cycle maximization strategies or face extinction.

Are you perplexed and in a dilemma how to keep in touch with frequent changes codes and related modifiers ?

Do not worry.OutSource or RightSource your EM specific coding worries to MedicalBillingStar.

We, at MedicalBillingStar :

1. Are well versed in the intricacies of EM specific coding services, with many satisfied EM customers across the US.
2. Can extricate you from this problematic scenario.
3. Are fully conversant with the on-going changes in the EM domain.
4. Ideally positioned to offer guidance and a safe passage for the EM fraternity through the thorn-ridden pathway.
5. In addition as freebies we offer free EMR consultation.We also provide pay for subscription involved in any EMR platform of your choice.We provide free EMR consultation services.

Infographics: Eradicating Impediments In Medical Claims Reimbursements

July 23, 2013 by Paul Martin Leave a Comment

Existing turbulent healthcare industry scenario :

In the current turbulent economy-ridden environment healthcare providers and physicians are not able to precisely and correctly claim the actual reimbursements of expenses incurred for diagnostic and treatment purposes from the insurance agencies, resulting in loss of revenue, profitability, incorrect claims, delayed claims, missing out on claims, the main reason being that they are not fully equipped to provide precise diagnostic and treatment documentation, backed by capturing the correct medical codes for medical billing. The physicians do not have the time to oversee capturing the correct medical codes and medical billing procedures as they have to focus on their core competency of diagnosis and treatment as first priority.

Vital issues compounding the problems :

Healthcare professionals are constantly under pressure due to increased patient/financial constraints and regulatory pressures, forecasting a doomsday for medical services. This situation is worsened further due to federal regulations that advocate improved, affordable healthcare services without comprising on quality issues even under the present economic scenario where the inputs for provision of healthcare services are experiencing spirally increased costs. To further complicate the issue, in-house administrative personal are not inadequately trained, inexperienced and lack the requisite expertise in medical coding and billing, as well as thorough and accurate clinical documentation.

The physicians would like to spend most of their time and efforts by focusing on core issues of diagnosis and treatment, rather than diverting their resources and energies over the nuances of managing and monitoring their to maximize revenue. Rather than have in-house medical coding and billing services, it pays to opt for outsourcing or right sourcing the billing services to established and experienced vendors. There is a dire need for in-house analysis of existing problems, solutions, future trends, and remedial measures.

The situation will further worsen in the near future since presently health care reforms are under way with focus on affordable health coverage and quality.

Medical Reimbursement Problems faced by Health Providers :

Insufficient knowledge or experience in medical coding and billing
Lack of training in medical coding and billing
Physicians using In-house medical coders and billers have to feel the consequences by struggling with inexperienced coders straight out of college
These billers and coders fail to cope up with evolving coding and billing guidelines, for medical procedures, and stay abreast with the latest procedures
Nightmares of lost revenue and unpaid bills

Lost revenue opportunities :

Physicians tend to miss opportunities to maximize medical reimbursements from the insurance companies.Lost revenue due to various factors includes:
Undercoding level of treatment,
Omitting modifiers,
Submission of medical reimbursement claims without the requisite documentation required to support the reimbursements.
Wastage of resources in determining and tracking reasons for claims rejected, besides finding out claims missed or under claimed.

The pathway to maximum reimbursement :

Out sourcing or better known as “Right sourcing” the medical billing and coding, clinical documentation, claims processing, EMR services to professional one-stop third party vendors results faster, precise and complete reimbursement of medical claims, boosting up revenue and profits.
Besides assigning the right codes for medical services the outsourcing vendor provides specialty specific coding services using experienced and AAPC credentialed coders on board.
The vendor is conversant with the significance of coding for the technical and professional components of a medical service, place of service codes, e/m codes, revenue codes, and when claims need to be bundled or unbundled.Compliance with all medical coding systems such as ICD, CPT and HCPCS ensures that working with such vendor is a smart option.

Remedial Measures :

Wise,prudent, and strategic to partner established third party vendors such as MedicalBillingStar who have long-standing expertise, experience in dealing with state-of-the-art coding and billing services to a wide range of categories in the US medicare industries.
Healthcare and medical units, irrespective of whether they are small, medium, or large, stand to experience hassle-free boost-up of medical reimbursements, without the nightmares of returned claims, missed-out claims, and piling up of rejected claims, and efforts to resubmit claims.
MedicalBillingStar closely follows the on-going trends in medical coding and billing and medical insurance claims processing methodologies.

The AMA Suggests That Physicians Should Focus On Billing. Are You?

July 10, 2013 by Ango Mark Leave a Comment

Are you losing out on billable dollars ?

This is not the best time to be a healthcare provider! Financial constraints and regulatory pressures are giving physicians, sleepless nights. Doomsayers have crawled out of the wood works to proclaim that medical practices are going to fold up and die.

It is certainly not like healthcare is circling the drain hole. But it is essential that medical practices up their game to stay afloat.

Still stuck with a payment contract that is five years old ?

The major mistake that healthcare practices make is to get paid much lower than the services they provide. Nobody likes getting on the phone and haggling with insurers. But what has to be done has to be done! Frequently negotiating reimbursement contracts will go a long way in increasing revenue.

Thorough claim analysis and evaluation of top paying CPT codes every three months can prevent and clot the bleeding.

It is okay to discuss money with patients !

Do you feel delicate when discussing about money with patients? Instead of dillydallying be forthright with your patients about treatment costs and payment options. Give them a lowdown on what and how much the insurer will cover.

A lot of patients promptly sue their doctor the minute they receive a bill. Discussing about payment prior to a medical procedure will prevent heartaches and heated arguments.

Don’t rely on straight- out of a- can solutions…

Most EMR/EHR systems come with coding and billing features. But no matter how loaded your system is, don’t lean on it completely. There are certain factors such as duration of treatment or the extent of injury that play a crucial role in increasing reimbursement. Middle of the road coding isn’t going to cut it anymore.

Why work just eight hours ?

As pressures mount and operational costs skyrocket, outsourcing has become a viable option. It makes a lot of sense to work with a billing company that works 24 hours. You not only process claims faster you can clear revenue backlogs.

Furthermore it is a nice feeling to walk in to your practice the next day knowing fully well that your biller has transmitted your claims to the insurer. And that now, finally, the accent will once more be on patient care.

ACO Wars – Pioneer vs Shared Savings Programs

July 3, 2013 by Ango Mark Leave a Comment

Well, it is not a war in the strictest sense of the term, but it does denote the recent developments in the ACO or Accountable Care Organization scene where many Pioneer ACOs have been opting out of the program due to difficulties in meeting the targets and the high risks involved. About 25% of the Pioneer registered Accountable Care Organizations are in the process of exiting the program and joining the lower-risk option, the Shared Savings Program. CMS had this to say about the fallout :

“We’re encouraged that these organizations want to continue in programs that promote better care at lower costs, we fully anticipated that as these programs get up and running, some organizations would shift between models.”

Health Reforms & ACOs

For those of you, who have been too busy to register what an ACO exactly is, it is a category of CMS program, which is part of the government health reform, which includes others like Patient Centered Medical Home, Medical Neighborhood, Health Home, etc. The reforms themselves consist of three main components, which is a superset of any practice models. They are :

a. Care Delivery Reforms.

b. Payment Reforms.

c. Health and Healthcare Community Reform.

ACO is a model which is, to quote a popular definition, “an organization, virtual or real that agrees to take on the responsibility for providing care for a particular population while achieving specified quality objectives and constraining costs.”

As the above definition clearly points out, an ACO platform is expected to stimulate more integrated care for the patients, which would ultimately result in quality improvements and healthcare cost reduction. Also, in these programs the ACO gets a share in the costs ultimately saved.

Pioneer vs Shared Savings Programs

SSP and Pioneer were two landmark ACO programs created by CMS. The latter has a slightly complex format, which takes into consideration organizations that already have some experience in providing coordinated care.

The Main Differences between the two are:

1. SSP has two payments tracks and it is upto to the ACO to choose either the non-risk sharing one (which has less cost savings share) and the risk-sharing track (which has higher cost savings share but at the same time there are possibilities of losses upto even 60%).

2. The Pioneer utilizes a trending methodology that, all other things being equal, produces a slightly higher benchmark than the SSP for high-cost areas.

3. The SSP will need to cater to at least 5,000 Medicare fee-for-service beneficiaries, whereas the Pioneer needs to service 15,000.

4. The Pioneer program importantly includes a clause that 50% of Pioneer ACOs revenues should come from participating in “risk” contracts with other non-CMS (private) payers.

The Significance of events such as the above

Republicans have been ardently opposing the health reforms (which is really an attempt for universal healthcare). The recent refusal by the National Football League to team up with the government to promote ObamaCare has been touted as some sort of vindication for their stance. Also, the refusal of some states to adopt the Medicaid expansion plan and the setting up of online HIE, to realize the goal of “healthcare for all” , is seen as further supporting evidence. And the above developments in the Pioneer ACO scene is construed by some health reform detractors as the “straw that will break the ACO camel’s back”.

MedicalBillingStar : A Voice of Sanity

With a decade of hands-on experience in servicing over 500 clients when it comes to the RCM Cycle, MedicalBillingStar always endeavors to float above the cacophony of healthcare gossips and half-truths, to provide their medical billing and coding clients with information that is relevant, besides of course catering to their entire RCM workflow. We are aware of the impact that ACO’s will have on payment models, the changes from which ultimately have to be incorporated into the RCM process. Thus, we keep abreast of the latest happenings in the payment model scene. Meanwhile you may call MedicalBillingStar at 877-272-1572 or visit our website at www.medicalbillingstar.com if you any questions about any of the above or the Medical Billing/Coding processes in general.

Complicated Crosswalks, More Codes And Stricter Documentation Requirements. But ICD 10 Is Not The Loch Ness Monster !

May 15, 2013 by Ango Mark Leave a Comment

Are you ready to get cracking on ICD 10 ?

The deadline for adopting ICD 10 is inching a little closer every day ! It is time for the eternal question. Are you prepared? A study by the Health Revenue Assurance Associates says that 20% of medical practices are yet to start an education or training program on ICD 10.

About half of the medical practices surveyed were way behind timelines set by Medicare and Medicaid. The transition is going to be tough. No matter what mild mannered, reassuring experts say ! And that is why the sooner a practice makes the switch, the better.

Confounding crosswalks…

Medical practitioners who think cross-walking ICD 9 codes with the latest codes is just a matter of few mouse clicks, have a second think coming. The General Equivalence Mappings does offer a detailed crosswalk of both the coding systems.

But the fact that there are very few one to one matches between both coding sets is going to make the transition, tricky.

According to a study by researchers from the University of Michigan and Illinois, mappings for specialists are going to be, especially, complex. Emphasis has to be laid on understanding and managing, mapping categories and networks.

A little bit of effort from everybody…

It isn’t the coding or billing team alone that is going to struggle with the new codes. It is going to take a bit of effort from all concerned.

As ICD 10 is all about greater specificity and granularity, physicians will have to focus more on the medical documentation they send to the billing team. More documentation could mean just one thing, more revenue !

Have you forgotten your insurer ?

Well, your insurer is a part of your team as well. Ask for a testing plan and send a few “test” claims to the insurer. Coordinate with your payers to make sure you are ready for the D day. Keep in mind that you cannot send ICD 10 claims till the compliance date. But don’t let that stop you, from sending out trial claims, to payers.

Why ICD 10 is not the Loch Ness monster, after all !

The entire hullabaloo surrounding ICD 10 makes the codes look like small, poisonous creatures, out to get physicians. In the long run ICD 10 can prove to be good for practices. It could mean more accurate payment for medical procedures. Fewer miscoded claims. And, a better idea of how much you’d be paid, prior, to a medical treatment.

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Lisa Maciejewski-WestCMC, CMOM, CMIS, MCS-P