Thursday, April 4, 2013

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.

Wednesday, April 3, 2013

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! 

Monday, April 1, 2013

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.

Sunday, March 31, 2013

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.