It’s mid-April, and most healthcare conductors are sounding out the last call for passengers to climb aboard. Although the trains won’t reach full steam until October 1, 2015, the test runs will commence shortly. You’re probably wondering why passengers have to sit through these test runs, right? This is because the journey will last for at least 10 years, so everyone needs to get accustomed to the environment of this locomotive.
Your practice is the train, you are its railroad engineer, the conductor is your practice manager, but who are the passengers? Surely not the patients; they don’t need to apply the codes, do they? The answer to both questions is no. The passengers are your medical billing software vendors, your clearinghouses, your payers, and most importantly – your billers and coders.
If you haven’t started inquiring if these stakeholders and their systems will be ready before departure, you could suffer from huge reimbursement disruptions once claims become dependent on these new codes. However, you still have time to get your engines running, and here’s what you need to do:
1. Contact Your Medical Billing Vendor
The first passenger on your train, irrespective of the number of trolleys you’re carrying, is your practice management (PM) or medical billing software vendor. This is because you need to enquire if your billing software is ready for the new codes. If not, you won’t be able to get your claims through because they’ll contain defunct codes.
Additionally, you must also enquire if the vendor has a clear mapping process to convert ICD-9 to ICD-10 codes. If upgrades cost extra, or if you’ll need more training, you should have that in mind beforehand.
Lastly, ask them when you’ll be able to begin internal and external testing using these new codes, and if they have any recommendations for streamlining the process.
2. Assess Your Billing Team: Outsourcing is an Option
Tell your practice manager to provide you with a detailed plan of how much training your billing team will need, and if you’ll need to hire an additional professional for coding. If these costs appear to be too high, consider outsourcing the service to a competent billing company.
You’ll need a fair amount of research to decide on an outsourcing company if that’s the direction you decide to go in, as there are a lot of sub-standard billing companies out there.
3. Ask Your Clearinghouse for Reports
If you’re using the services of a clearinghouse, tell them to provide you with a list of the following:
- Your top 10 payers
- Your most frequent denials and rejections
- Your most used ICD-9 codes, and their counterparts for ICD-10
- The date range between which you can begin external testing
Using stats for your top 10 payers, you’ll know which claims to pay additional attention to, post ICD-10 of course. The stats on current denials and rejections will give you an area to focus on prior to ICD-10. You’ll know that you’re making mistakes in certain claims more than others, and that they need to be fixed. This will also minimize potential revenue decreases once ICD-10 comes into effect.
Lastly, request for a list of your practice’s most used ICD-9 codes, and a list of their counterparts for ICD-10. Note that these codes might be more in number for each, as ICD-10 has more defined, lateral codes.
4. Get in Touch with Your Payers
Don’t forget to take your payers onboard, as they’re the ones responsible for replacing white electronic claims with green dollar bills. Ask them how soon you can begin external testing with their systems, and if their ICD-10 upgraded systems are compatible with your billing software.
With these passengers onboard, you’re all set to begin internal testing of these new codes until July, then commence more test runs in the form of external testing from June till September, and then begin the actual journey on October 1.
About the Author
Alex Tate is a Health-IT consultant & content strategist, who provides perceptive, engaging and informative content on industry-wide topics including EHR, EMR, practice management and HIPAA compliance.