Why and how must you immediately begin preparations for the ICD-9 to ICD-10 conversion?


Last year, the much debated ICD-9 to ICD-10 conversion deadline was delayed another year and set to October 1, 2015. However, numerous provider groups and stakeholders have been pushing for another delay, which would be the third in total, stating that the conversion will result in unmanageable financial pressure on the already challenged practices.

This article summarizes how ICD-10 differs from ICD-9, what the Congress had to say about the deadline, and in what way must you prepare for the conversion.

CureMD ICD-9 Into ICD-10

The new codes

The first question that most providers have is about the specific changes in the code sets. Here’s a summary:

* 68,000 diagnosis codes as opposed to just 13,000 in ICD-9

* A maximum 7 alphanumeric characters per code as opposed to 3-5 in ICD-9

* Very specific, more complex, and more flexible codes

* Lateral codes as well (different codes for right and left)

* 87,000 procedure codes as opposed to 3,000 in ICD-9

* 7 alphanumeric procedure code characters in contrast to 3-4 numbers in ICD-9

* With detailed methodology descriptions, procedure approach mechanisms, more detail, and flexibility

The Meeting

Last week, the Energy and Commerce Committee’s Subcommittee on Health held a public forum to discuss the ICD-10 deadline. The meeting panel comprised of experts and stakeholders from across the industry, and included doctors and EHR vendors.

The Response

Despite opposition from a few stakeholders who held the view that small practices wouldn’t be able to manage the new codes, the majority voted in support of the October 1 deadline.

The way forward

The response by the congress via the meeting is clearly tilted towards ensuring that the deadline holds. If you were anticipating a delay, and haven’t yet started working on the conversion; you can still manage. Here’s how:

  1. Contact your EMR and Practice Management vendor and enquire your system’s readiness for the conversion. Ensure that their software possesses the necessary updates and ICD-9 to ICD-10 conversion mapping tools to make certain that your system is ready for, and will facilitate the conversion.
  2. In the case that your vendor is not ready, immediately begin looking for a new system. This is because from October 1, your claims will not be processed on ICD-9 codes.
  3. Delegate an ICD-10 expert (from you staff, or hire a professional) to train your staff, and to devise and execute plan for the conversion in line with your practice workflows.
  4. Consider Outsourcing Medical Billing if your ICD-10 expert (and yourself) feel that your current staff will not be able to manage claims processing on the new code set.
  5. Get in touch with payers and clearinghouses to determine their readiness.

The target for completing these steps (apart from staff training which could be ongoing) should ideally be March 15.

  1. Next, you must begin internal testing of the new codes between March and April, to check how well your staff will manage the new codes. Ideally you should be done by this till the end of June at maximum; and make the necessary workflow adjustments to fix errors in which the process proceeds.
  2. After internal testing in June, you need to begin external testing with clearinghouses and payers to determine how well your test claims (with ICD-10 codes) will do once out of your practice.

It is imperative to identify and correct any slow or disruptive processes in every stage of your conversion process. Doing so will enhance the efficiency of your practice, and help make certain that you are ready and equipped for the ICD-9 to ICD-10 conversion by October 1.

UnitedHealthcare handed injunction by Federal judge


A Federal judge has ordered a temporary injunction against UnitedHealthcare based on the case filed by two Connecticut-based medical associations.

The decision came hours before the health insurer was set to drop thousands of physicians and patients from its rolls. This injunction prevented UnitedHealthcare from removing any of the doctors until the court can rule on the merits of the case.

US District Court Judge Stefan Underhill ruled Friday, December 6, that the Hartford County Medical Association and Fairfield County Medical Association have “met their burden of demonstrating that they will suffer harm that is imminent and cannot be adequately compensated through damages.”

The two medical associations from Connecticut were seeking a temporary restraining order against UnitedHealthcare to prevent the insurer from removing nearly 20% physicians on the panel from its Medicare Advantage networks. If it had gone ahead with its plans, nearly 30,000 patients would have been affected.

The court order means that UnitedHealthcare will have to start proceedings from the beginning. However, the insurer maintains that it plans to immediately appeal against the decision.

“We believe the court’s ruling will create unnecessary and harmful confusion and disruption to Medicare beneficiaries in Connecticut,” says Terry O’Hara, of UnitedHealthcare Group, in an emailed statement. “We know that these changes can be concerning for some doctors and customers, and supporting our customers is our highest priority. United Healthcare will continue to stay focused on the people we serve.”

This ruling will only affect members of Hartford County Medical and Fairfield County Medical associations. The affected physicians, more than 2,200 in number, reportedly belong to Hartford, New Haven and New London counties.

The judge ruled that UnitedHealthcare appears to have breached its contract with the physicians by removing them without cause or explanation, causing a violation of Medicare regulations.

For the time being, the injunction stays and only time will tell how this will shape up in the days to come.

Choosing a Medical Billing Service

Medical Billing – Comparing Both Sides of the Coin


While discussing the matter of medical billing in regards to any clinical practice, generally you come across two distinct opinions. Firstly, there are those who believe that the responsibility of maintaining financial workflows of a practice lies with the clinician, alongside managing other administrative and clinical aspects of the practice. On the contrary, there are physicians who believe in providing uncompromising patient care, which is why they prefer outsourcing their medical billing to an expert organization. It’s difficult to establish which option is better since both arguments have their inherent pros and cons. Let’s try to determine which option is a more viable strategy to implement within your practice.

The foremost argument for advocates of accommodating an in-house medical billing department is ‘why pay someone for a job that you can do on your own?’ One may regard this as a valid consideration due to the expense incurred by hiring an expert medical billing service. Everybody dislikes money going out of their pocket without an advantageous trade off; so the million dollar question arises, what gains are acquired from the transaction considering option number two?

Surveys and polls have elucidated that overall efficiency of a practice including the clinicians’ productivity have substantially increased once the billing processes have been outsourced to a specialized medical billing service.  The fundamental reasons for this phenomenon as cited by these surveys are improved revenue cycles and efficient claim management. A diminished number of rejected claims inevitably results in greater earnings for the practice.

“It’s a mystery why some physicians still opt to have in-house billing. This appears even more ludicrous viewing the exceptional positive impact that outsourcing to a medical billing service has on your practice’s finances. For those who consider their practice to be primarily a business, the argument of saving money by having in-house billing is flawed in my opinion. In comparison you spend more money in hiring trained professionals, or hiring novices and training them. Moreover, training your supplementary resources to perform these functions consumes valuable time. Your revenue cycles are unnecessarily extended and you do not have the resources at your disposal to process the maximum number of claims possible”, according to an Ohio based health IT consultant.

If you inspect closely whilst making a comparison, eventually both time and money are conserved if you outsource your medical billing to an expert and proficient medical billing service. Since a much larger number of claims are being processed, even a small percentage paid to a third party billing company eventually translates into a greater profit for your practice. Furthermore, since all financial responsibilities and intrinsic concerns are outsourced, it gives the physician more time on their hands to focus on their primary responsibility of ensuring delivery of quality care.  When all is said and done, the number of clinicians outsourcing their medical billing speaks volumes for its benefits. Specialist medical billing services are making a huge statement through their performance and paving the way for the future of healthcare industry at large.

 

Why is the Trend of Outsourcing Medical Billing Services Increasing by the Day?


In any organization, the finance department is of prime importance as it involves revenues. However, in this race of survival of the fittest, leading organizations are so busy in their core business concerns that they are not left with any time to look after their revenue cycle. In today’s world, as the service industry is growing more than any other industry, companies are more interested in satisfying their customers. However, it needs to be realized that if revenues are not managed properly, businesses won’t be having enough funds to continue their operations at full capacity. Same is the scenario in the health industry where physicians are fully occupied with their routine work that it becomes extremely difficult to maintain revenue cycle in a regular manner.

Therefore, in order to channelize the revenue cycle, care providers have started outsourcing their Medical Billing Service to external billing specialist companies.  Revenue cycle management is an intricate process that involves the verification of insurance eligibility, medical coding, Medical Billing, claims denial management, and ensuring timely inflows. In order to gain most from it, specialists are required to execute this complex process. The basic aim of efficient revenue cycle management is to waste as little time as possible and maximize practice revenues.

Business Process Outsourcing (BPO) is turning out to be a leading management fashion. Of course, the increasing popularity of outsourcing Medical Billing is linked to innumerable advantages it holds. By outsourcing billing to an external partner, healthcare providers enjoy streamlined revenue cycle, specialist services, low costs, reduced hassle, and faster revenue collection. In addition to this, as compared to in-house billing, there are low infrastructure costs, employee costs and lesser overheads.

Due to the aforementioned advantages, the trend of outsourcing Medical Billing Service is expected to increase in the future. However, before outsourcing such an important department, healthcare providers must check the skills and knowledge of the employees of that billing company.

 

Why Outsourcing Medical billing Service is a Good Idea?


In order to address the increasing problems faced by the healthcare industry today, physicians have adopted the trend of outsourcing medical billing service. Industry experts have marked it as a management fad that has enveloped the healthcare sector as well. Just like outsourcing any other business, medical billing is being outsourced due to several advantages associated with it. In order to get a better understanding of its advantages, it is important to know what medical billing teams actually do.

Such teams of professionals’ apply a number of skills in order to process claims on behalf of hospitals, physicians, and other institutions. These personnel are well conversed with market and industry knowledge which helps them to ensure the accuracy of medical data. They store information and transfer it accordingly to make sure it’s compliant with the Security and Privacy Rules of the Health Insurance Portability and Accountability Act (HIPPA). Billing teams apply their analytical skills to find any loopholes in the current system and endeavor to find a suitable remedy to fix it before it worsens.

By outsourcing medical billing service, physicians are transferring their load to personnel who are specialized in this particular field. These professionals know the ins and outs of medical billing system and cater to all the problems in the best possible way. Moreover, if physicians outsource medical billing service, they reduce their overall expenses by not having a separate department for Billing. Otherwise, establishing a separate department means allocation of extra resources in the form of space, technology, and human resources. By outsourcing, physicians can ensure compliance with the industry standards through working on the advanced technologies of the external partner. Then, most importantly, outsourcing medical billing service helps in reducing the number of claim denials hence, expediting the revenue cycle.

According to a leading physician who outsourced his medical billing service just recently, “due to my busy schedule, completion of billing process took a lot of time. This resulted in delays in payments and affected my overall cash flows. However, outsourcing it to an external partner increased my turnaround by many folds”.

Therefore, in order to achieve the optimum level of profitability, it is important to outsource the medical billing service to those who do it best. By doing so, physicians would not only experience an increase in their revenues but would also be able to focus more on their core job.

Why to Outsource Your Medical Billing?


Whether to outsource the billing operations to an independent medical billing company or opt for an in-house billing department is often a dilemma faced by most physicians. Looking at the basic principles of economics, the law of comparative advantage states that it is always beneficial to provide or avail a service that optimizes the cost structure. Providers should apply the same principle when faced with the aforementioned dilemma.

Physicians today are inundated with various challenges posed by modern day regulations in the healthcare industry. Thus given the time constraints, managing the day to day practice operations becomes increasingly cumbersome, especially without an efficient billing manager. Recent surveys also indicate that hiring additional resources for billing can result in an increase in practice expenditure and overheads, especially for smaller practices. However, outsourcing billing operations to third party medical billing companies is proving more effective for these practices, with providers able to benefit from experienced and knowledgeable resources at an affordable cost – usually a percentage of the collections.

Nonetheless, experiencing reduced costs is not the only benefit of outsourcing your billing. There are often cases where claims have been rejected because of errors in coding along with unnecessary delays. Having a specialist biller dedicated to streamlining the revenue cycle can reduce such errors and ensure quicker turnarounds, ultimately improving practice cash flow and profitability. According to a study conducted by software advice, an outsourced billing service is likely to increase collections by up to 10%.

The chances of fraudulent occurrences in-house are eliminated, when a third party is contracted to manage such operations.. As these companies charge a percentage of the actual collections for each provider, they need to ensure timely and efficient collection in order to bill higher. Managing these operations for multiple clients, they can easily spot discrepancies in financial workflows and provide detailed performance reports to each client on a regular basis. Today, most established billing companies also provide comprehensive financial analysis on a periodic basis and recommend strategies to enhance profitability.

Medical billing – When to Outsource?


Medical professionals continue to struggle with ever changing reporting requirements. As the healthcare industry moves towards performance driven reimbursement it is likely to continue to grow. However, outsourcing billing is not an immediate answer. Electronic documentation with the aid of EMRs has moved things in a positive direction as it drives evidence based documentation and simplifies data transmission between providers and payors. With almost 57% of office based practices now utilizing EMRs, medical errors are likely to reduce over time which should result in more accurate documentation and reduced number of denials.

While completeness of documentation carries importance, most practices are able to improve returns by maintaining a consistent relationship with payors. An efficient billing team is likely to remain on top of changes in regulations and payment criteria which results in better claim management. Claims are likely to be denied on the basis of errors in medical billing and coding or if services rendered are not covered or considered as irrelevant. However, with regular analysis the billing team can identify risks and create an appropriate plan through continued learning of the practice.

Account receivables need to be consistently monitored. Most practices choose to utilize the aging scheme method by pooling accounts of a certain age and devising an age specific strategy. Different follow-up standards could be devised based on the materiality of the amount owed and the age of the receivable. If the account is due over 120 days, there is a good chance its due to an error either by the practice or the insurance company. Almost 19% of the claims denied can be attributed to errors by the insurance company.

An age of 120 days is unfortunately common for providers, as almost 10% of accounts receivables for most practices are likely to be above that figure and have to be written off as bad debts. Medical billing companies are slightly more aggressive in their approach, which can sometimes pay off where internal billing has been inefficient. Practices suffering from aged accounts are likely to gain more by outsourcing to an efficient medical billing service especially since most medical billing companies charge their clients based upon their collections.