Payer Issues with ICD-10-CM

With the new code set we see that there are many changes. More specificity for instance means more documentation is required , which in turn means the reimbursement will possibly increase with these codes but the requirements for the higher reimbursement  will also determine how these codes are submitted.  Another thing to note just as codes may cause an reimbursement increase they may also cause a decrease in reimbursement for the ones that do not require as much documentation. This change in the code set alone will surely have an affect on your "normal" reimbursement from specific payers.

Front Office Chaos Creates Distractions

The Front Desk Drama 

How does your front office run on a daily basis?  Is the phone constantly ringing off the hook, are patients waiting impatiently for appointments to be scheduled, are charts forever disappearing from the front desk......if this is the norm for your front office it could mean one of two things. Your practice is thriving, you have more patients than you can handle and business is booming or this could be a sign of disorder and constant confusion. Regardless of your answer,as the big date October 1, 2014 looms over our heads it's time to gain control over the front desk. Did you know the front office has a direct effect on two main components of the medical practice: customer service and the financial bottom line. If chaos is the norm for your office, I can assure you that these distractions are creating errors, that will end up in the billing department, which causes write offs, which leads to revenue loss. Let's face it, if patients are not receiving courteous customer service they are likely not to return or refer their family or friends to your practice which ultimately causes revenue loss. The front desk is truly the face and frontline of your medical practice....it's time to tackle, address and revamp the problems and get ICD-10-CM ready! 

How to Become ICD-10-CM Ready!

So What Has Changed?

Lets begin by identifying what has changed with ICD-10-CM 

●We have gone from mainly all numerical codes to alphanumeric

● Place holders were put in place on some codes to future expansion

● Title changes

● Directional changes in categories

● Name changes for codes

● Expansions for codes they may have only been one code for ICD-9

● Codes that were expanded previously may just be one code now

● Some codes deleted all together 

● Laterality on sites

● Understanding the new Excludes 1&2 difference

That's a lot of change right there and that was to name a few! But please understand this, there is no way you can 

learn all the codes , all the changes needed all at once. Ask yourself this question do you know all the ICD-9

codes?? Of course you don't but you are familiar enough to know how to handle your daily coding needs in order for your office to run somewhat smoothly. So if you don't know all the previous codes, stop trying to learn all the new ones. Focus on what you need to learn, focus on what will make your office transition into this change smoothly,  and focus on the issues that may cause some reimbursement challenges in the future.  That is how you become ICD-10 ready.

How Insurance companies are banking on your ICD-10-CM mistakes!

Everyone is preparing for ICD-10-CM readiness, even the payers. Yes they are conducting system checks as well as updating their existing systems in order for claims to have a smooth payer transition but lets look a little deeper at this situation. Every month as you conduct your end of month close out on accounts, you run numerous reports CORRECT? Well wouldn't it make sense the the insurance companies are running reports as well, and guess what they have that automatically targets your practice. All the erorrs and rejections you send them each and every month.  Now if I were a betting man, I would bet they aren't that concerned about you correcting an issue for ICD-10-CM readiness that you have yet to correct for ICD-9-CM. This makes life so much easier for payers to target what areas they can hit you continually with rejections as you transition into ICD-10-CM. Make no mistake about it, can you afford to keep feeding payers information like this,  No you cannot!!....the time to fix this issue is NOW!.......don't make it easy for them to deny reimbursement to your office. Take control of your practice now, so you will not have to play Russian Roulet every time you send your claims a out to the payers after Implementation begins.

Start your office Library for ICD-10-CM

As you begin to implement changes for ICD-10-CM, you will soon have loads of resource material that will be beneficial for your office needs. You must maintain a reference area in your practice. Label binders and folders for every issue addressed, all information obtained through reports, documentation anything and everything. Make this library a reference point of knowledge, customized just for your practice. Having a reference library will be a time saver as well as being your customized resource station specifically deigned by your practice for your practice. Plan to Succeed!

ICD-10-CM Impact on your practice revenue stream:

How to handle the revenue stream before it handles you !

In previous post we have discussed the importance of running billing reports of commonly used codes. This aspect of handling your revenue stream will be vitally important after Implementation.  

1. Identify revenue received from ICD-9 codes
2. List each code separately and reimbursement amount
3. After Implementation begins create spreadsheet for cross walked codes, identify reimbursement amounts as well as any changes you can identify. Track this information for at least 60-90 days after Implementation 

These 3 steps will be vital in tracking expected reimbursement as well as giving clear indications of revenue gain or loss....

Sneak Peek into ICD-10-CM

A Sneak Peek into ICD-10-CM is just a glance into our future. All the new and exciting changes we have to look forward to in 2014. The design of ICD-10-CM was to offer significant advantages over ICD-9-CM. The changes themselves should result in significant improvements in both the quality and the usefulness of data for various healthcare settings.

Cyst category under Bursa will be expanded out to identify not only location but laterality as well, this will be very common in Ortho with ICD 10. Physicians will have to be more specific in identifying location and laterality in order to code properly. Bursa will go from just one code 727.49 to M71.30 , showing up in ankle, elbow, foot, hand, hip, multiple sites, pharyngeal, popliteal space, shoulder, specified site and wrist, also including extenders to show laterality.

The use of these codes in ICD-10-CM has not been approved for use,but we at The Virtual Coder, have put together a quick glance into someof the changes that will impact all of us in the year to come, but what this information will also do is help to familiarize yourself with the differences so you too will be prepared for what is to come!

                                      Magic of Tackling  ICD-10-CM

There have been so many changes from ICD-9-CM to ICD-10-CM. The thought or idea of trying to learn all of them is crazy!  The most efficient way to learn all of this overwhelming information is to only focus on what you need to know right now. How do I make that happen you may ask? Well if you are an office manager, coder, biller and have a way to access the reports that have the codes your office is now using, you have tapped into the magic of tackling ICD-10-CM.  Create a crosswalk from ICD-9-CM to ICD-10-CM.  I know some of you are saying our system already does that!...Great but does you system indicate how the code has changed, I'm going to answer that for you ....NO!  Customize your codes to fit your practices needs yourself, and you have found the magic!