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Medical Coding and Billing Challenges in 2015

February 27, 2014

2014 ChallengesMajor changes stemming from the Affordable Care Act promise to make medical coding and billing more difficult in the coming year. Regulations that are effective as of January 1, 2014 require more documentation in order for medical practices to complete the billing process. Understanding these changes is the first step to proper billing. M-Scribe provides medical billing and coding services that allow medical practices to overcome the challenges facing them in 2014.

Diagnosis Codes

The biggest change that will take effect this year is the transition from ICD-9 to ICD-10. The switch means that the number of diagnosis codes will expand from 13,000 to 70,000. A huge increase in the number of codes has the potential to decrease earnings for medical offices and may cause confusion for employees who are not adequately trained on the new codes.

Offices that are not prepared for the change may have difficulty collecting payments. The changes set a strict definition for medically necessary procedures, and claims that use invalid codes that were acceptable under ICD-9 are likely to be denied.

The good news about the change in diagnosis codes is that medical practices have until October 1 to comply. The overhaul is an undertaking that is too labor intensive for most offices, but outsourcing medical billing and coding to M-Scribe lets practices comply with ICD-10 without the commitment of time.

CMS 1500 Form

A new CMS 1500 form will be used in conjunction with the new ICD-10 coding. Documentation must be accompanied with the CMS 1500 form that is now available. Claims made using outdated forms will not be accepted starting April 1.

Current Procedural Terminology

Changes in the CPT are intended to standardized terminology that is used in medical practices across the country. However, significant modifications that require full compliance could put a strain on providers. Providers who use software to complete their medical coding and billing tasks have the option to import the new CPT codes into their existing software packages.

Quality Standards

The quality reporting program managed by the Centers for Medicare & Medicaid Services will be able to levy penalties for noncompliance in 2014. Providers are required to complete checklists that review the quality standards of routine procedures and surgery for patients who are enrolled in Medicare or Medicaid.

Ambulatory surgery centers that failed to comply with G-code reporting standards between October and December 2012 will receive a 2 percent reduction in the reimbursement amount for Medicare claims. This penalty will also be applied to ASCs that fail to comply in the future, so it is essential for providers to be proactive about compliance.

Technological Needs

Changes in patient volume will force medical offices to move to digital medical coding and billing. While most offices have already switched to digital medical coding and billing, approximately 20 percent of hospitals and nearly half of physicians still need to make the change.

Expanded access to insurance is sure to increase patient volume significantly. Medical offices that struggle to manage paperwork will not be able to keep up with the change in volume without the help of computer programs. Outsourcing medical coding and billing is one way to benefit from digital processing without the need to purchase a software package or take the time to train administrative professionals on the changes in medical coding and billing.

Medical coding and billing changes in 2015 pose unique challenges to providers. M-Scribe is available to provide medical coding and billing services to ensure compliance with regulations put into place under the Affordable Care Act.


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