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Private Practices Should Start Preparing for ICD-10 Coding.

January 28, 2013

Private Practices and ICD-10No change comes without costs. The transition from ICD-9-CM to ICD-10 is no exception. It can be comfortably predicted that the upcoming change in the medical billing industry are going to cost unprepared outpatient medical practices. To reduce exposure to reduced revenues after the transition, it is imperative for physician billers to be ready to submit the new codes contained in ICD-10-CM for proper payment. 

Industry surveys reveal that many outpatient practices are not taking the necessary steps to prepare for ICD-10. Put a frog in a pot of water and put the pot on low heat.  The frog won’t realize the water is boiling until it is too late. That’s what the upcoming ICD-10 transition is like. Time is wasting while few practice managers ignore the heat.

On October 1, 2014, healthcare billing will change dramatically. The coding system that has been used for decades is about to be replaced. Outpatient physician practices ignore this impending change at their peril. Hindsight may be 20/20, but foresight will save the bottom line.

Medical practices that perform all their billing functions in house are at particular risk of losing or delaying payments by not preparing for ICD-10. Some doctors say, “We have over a year until we have to be compliant.”  That’s true. In medical school, none of them said, “I won’t have to practice medicine for another six or eight years. Why study now?”

Medical practices that use a third-party billing company are at less risk. Professional medical billers, coders, and documentation specialists are already preparing themselves for the ICD-10 transition. Mastering ICD-10 now will prevent dirty claims from being submitted in 2014 and beyond. The best defense is a good offense. Providing reliable, efficient service, submitting clean claims that don’t need to be appealed, and posting accurate, timely payments to a practice’s A/R is essential to keeping a client’s practice financially afloat.  

Is it too early to think about ICD-10?

Is it too early to screen for breast cancer when a woman has a palpable lump? Is it too early to order an ECG on a patient with cardiac symptoms? Is it too early to perform an annual physical exam on an established patient? Is it too early to ask probing questions to evaluate a patient’s current health status?

ICD-10 is coming. Business practice, like clinical practice, requires preventative measures.  Now is the time to consider the financial impacts of ICD-10.

While hardware and software requirements for ICD-10 billing should have been satisfied with the recent 5010 transition, medical practices who conduct all their billing operations in house need to be ready for further upgrades once ICD-10 is implemented. It is not too early to consider the expenses needed to be 100% compliant with the new standards. Bad software will cause claims to be denied because they do not include codes to the highest degree of specificity required by ICD-10 standards. In-house back office staff cannot be expected to be able to transition from one coding system to the other without adequate training.

Smaller Private Practices are Vulnerable to ICD-10

Medical practices that contract with a professional billing service have an advantage over the competition. Surveys show that physicians who contract their billing to third parties will have less exposure to a reduction in cash flow and in denied claims after October 1, 2014. This is because third party billers will be fully trained, and the medical record software used to transmit data between medical provider and billing agent will be compliant with the new coding methodology. 

Training costs will be negligible for medical practices who use a professional billing service.  The billing service will absorb the costs of training because it is in the service’s best interest to provide exceptional value. Healthcare providers will need training to familiarize themselves with the new standards, but the coders who submit claims will already be fluent in the new coding system.  

M-Scribe is ahead of the curve. We are anticipating the upheaval that the ICD-10 conversion is going to cause. We are prepared to submit clean claims from Day One of the new era.


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