ICD-10 Denial Risk Sparks Revenue Growth Opportunity For Emergency Coding and Billing

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ICD-10 preparedness is more than just about meeting the Oct. 1, 2014 implementation deadline, it’s about the possible impact to your emergency medical practice revenue cycle management following the “go live” if you’re not. There’s talk about a possible increase in denial rates during the transition, which can reduce practice profitability, or possibly even bring it to a screeching halt. Denial rates potentially could increase between 100 and 200 percent, AR days increase by 20 to 40 percent, prolonged declining payments and a near doubling of claim error rates.

ICD-10 has prompted a Y2K response. That’s because the transition from ICD-9 to ICD-10 in a little more than a year will transform the way payers, providers, staffers, coders, suppliers, third-party billing services, clearinghouses and others covered by HIPAA do their job – which directly relates to the ability of the IT systems and processes that support them. All these elements have a direct effect on emergency surgery coding and billing and ultimately your practice’s revenue stream.

To compound matters, CMS developed GEMs “crosswalks” to provide a path between ICD-9 and ICD-10 code sets. However, only 5 percent of ICD-10 codes are an exact match to ICD-9, which results in local interpretation and increases the potential for emergency coding, billing and collections errors. And, it will be necessary during the transition period to operate both billing systems concurrently, depending on when services were rendered, and payer and provider readiness.

All this being said, you can turn your ICD-10 transition risks into revenue opportunities that optimize your healthcare revenue cycle management. Did you know payers may start using the conversion to ICD-10 as another way to optimize your practice reimbursements?

The key is awareness and preparation. The more prepared you are in terms of people, processes and technology today, the better you will be able to respond to the changes ahead.

How do you prepare?

First, you need the right medical coding, billing and collections team with special expertise in emergency medicine revenue cycle management, and correlating ICD-10 implementation and compliance. They can help you:

  • Schedule training not just for coders but for anyone who touches the patient from registration through billing.
  • Have a strong denial management protocol in place to determine the root causes of denials, identify gaps and take remedial action.
  • Learn which tools and systems will be affected by the transition to ICD-10, and prioritize the opportunities.
  • Conduct comprehensive, trended reporting for financial metrics, especially as it relates to denials management.
  • Work closely with payers and vendors to ensure a seamless transition to ICD-10 billing and reimbursement.

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It takes contracting with a third party, independent medical coding and billing with special expertise in emergency billing and coding, and ICD-10 implementation and compliance to implement these steps and more to keep your practice secure and profitable. They understand the ICD-10 guidelines, GEMs, all the nuances of the training process and why knowledge of anatomy is so important.

With 68,000 diagnosis code and 87,000 procedure codes, an exacting level of specificity in your documentation is critical to pinpointing the right code. One incorrect character and your entire claim will be rejected. That’s why emergency coding expertise makes all the difference. Coders with the right training are able to deftly translate clinical information from the operative report into the ICD-10 system. The best trained ones know how to correctly document co-morbidities, manifestations, etiology/causation and complications with painstaking accuracy.

revMD.com offers technology integration with a knowledgeable and passionate medical practicing billing and coding staff to give you peace of mind as we build you a lasting and profitable practice – yes, even through the ICD-10 transition.

revMD.com is the results-proven alternative for physician medical billing, with a niche specialization in emergency coding and billing, ICD-10 and PQRS preparation that generates unprecedented results and builds profitable medical practices. Leveraging a history of industry wide success spanning 26 years, revMD.com partners with medical practices throughout the U.S. to optimize revenue for hospital based and community based physicians. For more information, visit www.revmd.com.

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2013-10-15T09:17:09+00:00