ICD-10: The Future of Medical Billing

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  The new implementation date for the conversion to ICD-10 is October 14, 2014. While that may be almost two years away, preparing now for the future changes is paramount to maintaining the biggest source of revenue; insurance billing.  ICD-10 has been pending as an upgrade to the existing ICD-9 code sets used by medical practices […]

 

The new implementation date for the conversion to ICD-10 is October 14, 2014. While that may be almost two years away, preparing now for the future changes is paramount to maintaining the biggest source of revenue; insurance billing. 

ICD-10 has been pending as an upgrade to the existing ICD-9 code sets used by medical practices today, however, due to numerous challenges and slow progress of adoption, the deadline for implementation has moved back several times. It is unclear at this stage if the October 14th deadline will remain, but either way, it’s a good time to formulate a plan for the implementation.

Informed and Organized

ICD-10 is going to change everything about billing as every aspect of the coding system is changing. The chart below shows a few of the highlights such as changes in the length of the actual codes to the availability of the codes for each procedure.  ICD-10 has more than 87,000 codes for every type of service and each code has a systematic layout. In ICD-9, the first digit may be alpha or numeric.  In ICD-10, the first digit is always alpha, followed by two digits that are numeric and finally the next four are either alpha or numeric depending on the procedure. 

  

ICD-10 is also going to be very specific on the coding. For example, 649.51 is related to complications during pregnancy under ICD9. With ICD-10, that now converts to three possible codes (O26.851, 852,853) related to the trimester in which the incident occurred. That means physicians have to be specific when charting and billers have to be thorough and specific when preparing the claim.  A good starting point is to prepare a list of the most used ICD-9 codes, and set up a table to reference the ICD10 variants. This way, your billers know exactly which codes to use and when.

Analyze and Re-Design

Have you taken the time to analyze your billing performance?  Business Analytics tools, such as those offered by Capgemini, are a good way to start. With all the data around coding and billing, business analytics can help identify payment trends and even more important – denial treads. Insurance companies deny claims for a multitude of reasons and by tracking those reasons you can find commonalities within the process. Even further, you can identify these common issues by insurance carrier and start to design a plan to address the root causes of the issues.  The example below depicts the process.

Process re-engineering requires some level of expertise with the existing billing structure.  With timely filing windows and special requirements by carrier, having a team of subject matter experts will help create a structured approach. Once our experts have helped realign the process, Business Analytics continuously measures the results to identify weaknesses and adjustments are made quickly. 

Look Ahead

Like with any other change to an organization, implementing a process on the scale of ICD-10 can be very daunting. Breaking down into steps using methods like PDSA (Plan, Do, Study, Act) or DMAIC (Define, Measure, Analyze, Improve, Control) can help structure the approach. Partnering with a vendor that not only has the experience in the industry, but has already taken steps to understand the coming changes can help cut costs, save time and ultimately make the transition a smooth one.

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