ICD-10 Preparedness Considerations from the Revenue Cycle POV

PracticeMax prepared a series of frequently asked questions about ICD-10 and its impact on physician and provider practices.

Q: What benefits and disadvantages emerge when comparing inhouse billing/coders (who have yet to be trained) to outsourced revenue cycle management services?

  • Effective and thorough coding and ICD-10 training takes time, money and resources
  • In some practices the person (s) responsible for coding has other job juties (billing, front desk, medical records) and may not have adequate time or skill set to focus on the ICD-10 transition and its impact on the many aspects of a medical practice. This will lead to cash flow and claims issues once the transition occurs and beyond
  • At PracticeMax, it is our job to remain up to date on regulations like ICD-10 and its impact on our clients
  • Older practice management systems may not be updated and practices will need to upgrade to systems that accommodate ICD-10

What are a few quick tips for small practices that are not so obvious or well know?

  • Any prior authorization forms that currently use ICD-9 codes need to be updated with ICD-10 codes
  • The General Equivalence Mappings (GEMS) crosswalk is not sophisticated enough to use for one to one ICD-9 to ICD_10 code matching; GEMS won’t help you get paid
  • Superbills for ICD-10 will be significantly more pages in length due to increased specificity and complexity of the new code set; an example family Practice Management superbill went from 2 pages to 9 pages

What is really necessary for successful inhouse biller/coder taining?

  • At PracticeMax, we follow the guidance of the American Academy of Professional Coders (AAPC) for coding education and certification. For certified coders to be prepared for the ICD-10 transition, expect the following:
    • AAPC Basic ICD-10 Training 36 hours + AAPC Refresher Coding Training 4 hours = TOTAL TRAINING is at least 40 HOURS
    • In addition to the 40 hours of training, additional hands on experience is recommended
  • If you are currently using a book for coding it’s time to upgrade your technology and use electronic resources such as www.mycodingtools.com, a virtual library of all things coding. It features an ICD-10 build a code and is a comprehensive resource for ICD-10 coding

What are some disclaimers for the practice reluctant to adopt revenue cycle management services as it relates to ICD-10?

  • ICD-10 will impact eery aspect of the medical practice not just coding
  • As revenue cycle partner like PracticeMax can help you assess and prepare for all of these aspects including:
    • Documentation for physicians, nurses and labs
    • Clinical areas such as patient coverage, superbills and advanced beneficiary notices (ABNs)
    • Management aspects such as policies and procedures, vendor and payer contracts, budgets and training plans
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