Reactions to the looming changeover from ICD-9 coding standard to ICD-10 scheduled to take place October 1 range from general confidence to serious worry. There is little debate that ICD-10 is better. It will make codes more meaningful, allowing medical practices to pack more information into a simple code. This will make it easier to track individual health problems as well as societal health trends.
The problem is, ICD-10 has several times as many codes as ICD-9 does, and learning ICD-10 has been compared to learning a foreign language. As with two different languages, direct word-for-word translation doesn't always work because the underlying structures differ. Looking at the experiences of other countries that have switched to ICD-10 can give American healthcare providers information about how to approach the coming transition.
Dangers of Misinterpreting Coding Guidelines
Misinterpreting coding guidelines under ICD-9 has sometimes been an issue. For example, improper diagnosis codes for malnutrition were examined by the Office of the Inspector General (OIG) of the Department of Health and Human Services in 2014, and it became clear that categorizing malnutrition was a challenge for hospitals. From just three hospitals studied, the OIG found Medicare overpayments of nearly $1 million due to improper diagnosis codes for malnutrition.
Failing to code diseases and procedures correctly results in incorrect claims, and sometimes in Medicare overpayments, which can cost facilities both financially and in terms of time spent correcting the problem. Facilities that do coding and billing in-house have to ensure the medical billing software they use accurately interprets coding guidelines now, under ICD-9, and will do so under ICD-10 once October arrives.
Ensuring Clinicians Understand the Transition Sufficiently
Outstanding medical billing software is a necessity, but it isn't sufficient for ensuring a smooth change to ICD-10. Not only do billing and coding staff have to be educated and trained on using ICD-10, clinical staff must understand what's going on as well. Productivity slowdowns are expected during the transition, and these slowdowns will be worse if clinicians don't understand what they need to do differently to make ICD-10 work.
After ICD-10 starts, if doctors and nurses provide only partial information that coders don't find to be thorough or specific enough, records will have to go back to clinicians for clarification. This to-ing and fro-ing can cause accounts receivable days to increase beyond what might be caused by ICD-10 transition pains.
Having Cash Reserves or Access to Lines of Credit Is Smart
Even with trained coding and billing staff and good medical billing software, medical facilities can expect some degree of cash flow crunch come October. Expect an increase in accounts receivable days and take steps to ensure sufficient cash flow so your practice can pay its bills on time. A "belt and suspenders" approach is best, by having both cash reserves and lines of credit available. A serious problem with the ICD-10 transition could cause your practice to burn through cash reserves faster than you expect, necessitating use of credit as a backstop.
Outsourcing versus Using High Quality Medical Billing Software
Some practices will choose to outsource medical billing and coding, but this is not always optimal. When contractors handle coding and billing, their mistakes (which you might not catch right away) can hurt your revenues. Most practices want to be in control of the moving parts of the revenue cycle, and this means investing in high quality medical billing software, plus the training required to make the most of it.
Outsourcing must be carefully considered so you can be confident of the security of medical records. A combination of medical billing software and working with revenue cycle experts can work wonderfully in terms of maintaining revenue cycle control while ensuring processes are as efficient, accurate, and streamlined as possible.
This autumn will bring all the usual challenges of running a medical practice, plus the additional challenge of switching to ICD-10 coding. Outsourcing the medical billing can be a wise and profitable deicison for practices that are not ready for ICD-10 or the number of denials expected to occur with ICD-10.
At GroupOne Health Source, we provide a complete revenue cycle management service to help practices build a brighter financial future. With extensive experience in all phases of the healthcare revenue cycle as well as electronic health records, our EHR and billing professionals help medical practices maximize revenues while minimizing billing and coding errors.