10 Ways to Prepare for ICD-10 Codes

10 Ways to Prepare for ICD-10 Codes

A massive change is coming to the medical billing arena on Oct. 1, 2014 with the official rollout of the ICD-10 codes. ICD-10 codes will replace the ICD-9 codes currently in use, adding more than 68,000 new coding options that will directly affect documentation, billing and reimbursements for all healthcare providers.

ICD-10 codesIt’s essential that practitioners begin preparing now to reduce potential payment problems and delays when the new codes go into effect.

So who does this impact?

Does it impact the front desk, the clinician or the biller?

The answer – It impacts every single person in your practice. Those who won’t prepare will learn the hard way, and the lessons will reverberate through the staff for a long time.

Here are 10 things to know to prepare your practice for the upcoming ICD-10 code switchover on October 1, 2014.

1 – ICD-10 Replaces ICD-9

After Oct. 2014, only ICD-10 codes will be accepted for billing and diagnostic purposes. Remember, this applies to the date of service, not to the date of submission of the claim. So if the date of service is before October 1, 2014 and submitted after October 1, 2014 (and there will be several cases like this in your practice), you’ll still use ICD-9 to code those visits.

Any claim with a date of service after October 1, 2014, that doesn’t use ICD-10 codes will automatically be rejected, but practitioners can’t use the new codes before the official launch date.

The new alpha-numeric codes represent the International Classification of Diseases for expanded accuracy.

2 – The Change Is Mandatory And Necessary

It’s a mandatory transition that all clinicians must make if they want to be paid. The codes reflect new diseases, conditions, treatments and technological advances.

It’s the first update in 30 years, providing clinicians with additional coding tools to diagnose and treat patients.

3 – ICD-10 Codes Affect Everyone

The new codes affect all healthcare providers, from clinicians to hospitals. Being prepared will minimize delays and denials in payments and ensure that everyone in the office is familiar with the technology being used to implement the change.

4 – Your EMR Should Map ICD9 to ICD10 to SNOMED Codes

An electronic medical record sofware like In Touch EMR will help your practice adapt to this monumental coding change. Sophisticated systems like In Touch EMR will seamlessly managing all the new codes and allowing your practice to bill efficiently. The system you choose must have a crosswalk between ICD-9, ICD-10 and SNOMED codes built in. A system like this will allow you to generate compliant documentation and clean claims, allowing you to maintain or increase cash flow in your practice.

Here’s an example of a crosswalk, which should automatically exist in your EMR system. This crosswalk will train, and alert your clinicians about ICD-10 and make the transition seamless.

We’re going to use the sample ICD-9 code of lumbago, one that most rehab professionals are familiar with.

7242  LUMBAGO

CROSSWALK DETERMINATION

ICD-10 CODE
M545  Low back pain

SNOMED Concept ID(s)

279040009  Mechanical low back pain (finding)
402245001  Angry back syndrome (disorder)
298236009  Lumbar spine stiff (finding)
279039007  Low back pain (finding)
247368002  Posterior compartment low back pain (finding)
301407002  Tenderness of right lumbar (finding)
279041008  Lumbar trigger point syndrome (finding)
278860009  Chronic low back pain (finding)
301408007  Tenderness of left lumbar (finding)
278862001  Acute low back pain (finding)
300957005  Postural low back pain (finding)
279042001  Lumbar segmental dysfunction (finding)
161894002  Complaining of low back pain (finding)
267982002  Pain in lumbar spine (finding)
202794004  Lumbago with sciatica (finding)

As a clinician, you need access to this crosswalk at your fingertips, as the countdown towards October 1, 2014.

In fact, your EMR system should have the capability to show you which ICD=9 code corresponds to which ICD-10, and which SNOMED code. This will train your clinicians to understand which ICD-9 codes correspond to which ICD-10 codes right away.

When the big day comes in October 2014, this ‘crosswalk capability’ in your technology will make your transition seamless. Without this capability, practices and billers across the country will be scrambling to adjust to the new changes.

Even if you don’t have a crosswalk like this built into your EMR system, you’ll need to purchase / identify crosswalk data for the most common ICD-9 codes in your practice and start studying that data right away.

5 – Early Preparation Is Critical

The change-over takes place promptly on Oct.1, 2014 and reflects a one-year delay issued by the Department of Health and Human Services. While that may sound like plenty of time, early preparation is critical to the process.

Clinicians will need time to install any needed software, train employees, conduct tests and work out any bugs in their system.

An implementation strategy must be developed, along with a timeline and impact assessment evaluation. Practitioners will need to communicate with vendors, clearinghouses and insurances agencies to ensure security and compliance.

6 – CPT Codes Will Stay The Same

ICD codes are for making a diagnosis and current procedural terminology (CPT) codes are for medical and rehab billing. The next generation of ICD-10 codes won’t affect the use of CPT codes for physician services.

7 – Identify Any Needed Documentation Changes

The change to ICD-10 will require clinicians to modify or change their documentation processes. In fact, a significant increase in documentation time is expected, according to several industry sources.

Practitioners using an EMR must have the ability to create custom templates for documentation.

This will make it easier to implement any changes needed, allowing practices to take full advantage of the codes for enhanced care and revenues.

8 – Make Conversion a Top Priority

The change to ICD-10 codes should be a top priority for clinicians across the nation, even though it will require a significant amount of time and effort to ensure the transition goes smoothly.

The change-over represents a complete overhaul of the coding system and clinicians that don’t invest the time to prepare properly will find significant delays in reimbursements, or potentially costly system glitches.

9 – Be Prepared for an Emergency…ICD-10 codes

Part of the conversion process includes a contingency plan in the event that a major problem manifests.

Employees should be cognizant of who to contact and be able to do so 24/7 to have their office systems up and running again quickly. It’s best for practices to have a financial contingency in place in case payments are delayed or paused for a period of time. A line of credit, or access to emergency funds is important to meet expenses like rent, payroll and supplies.

10 – Invest in Education for your Staff

The best thing practitioners can do for their practice is to educate themselves and their staff to keep informed of any changes relating to the coding change.

Identify and schedule training for anyone within the office that will be directly involved with the billing and coding process. The clinicians and the billers need to identify courses on ICD-10 preparation and study crosswalks by working closely with their EMR vendor.

The change to ICD-10 codes is mandatory, affecting everyone in the healthcare industry and the time to prepare for implementation is counting down with each day.

Clinicians have a variety of resources to call upon and should make a concerted effort to ready themselves and their staff for the October 1, 2014 deadline.

Practitioners shouldn’t count on another implementation delay because this deadline is not going to be delayed. It’s going to happen and all practices need to be prepared for it.

Codes: A Fast Guide to the Medical Codes ICD-9 System

Codes: A Fast Guide to the Medical Codes ICD-9 System

A patient calls it a sore throat, a doctor calls it pharyngitis and healthcare insurance calls it a 462. Each is accurate, but if the correct ICD-9 code isn’t entered or doesn’t match the diagnosis, the physician won’t be paid for his services.

Designating the right ICD-9 codes is essential to collect reimbursement claims and Nitin Chhoda offers a crash course in the coding system.

codesICD-9 codes are the internationally recognized three- to five-digit numerical designations for each condition and disease.

The codes are organized into three categories known as volumes that are used by medical professionals across the nation for billing purposes when submitting reimbursements claims.

Medical Codes Development

Developed by the World Health Organization, the system is comprised of volume 1, a compendium of diagnosis codes for diseases and conditions.

Volume 2, arranged in alphabetical order, provides an index to diagnostic procedures and volume 3 lists procedure codes. The system is set to be updated in Oct. 2014 to the new ICD-10 codes.

The new system reflects advances in medical terminology and technology, and enables practitioners to provide more detailed information to insurance companies. Early preparation for the switch is advised, as those in the medical profession are anticipating some disruptions during the transition.

The Coding System

The ICD system links a diagnosis with a procedure for billing purposes. The codes tell insurance companies why the client met with the clinician, the diagnosis, and procedure or treatment that was provided to return the patient to health. The codes are further broken down into subcategories and sub-classifications.

ICD-9 codes offer provisions for making a multiple diagnosis, which can also be entered in an electronic medical records system. The first diagnosis code is used to explain the reason the client was seeking care. Other conditions may be observed during the examination or be part of the patient’s medical history.

Those are placed second and third on claim forms as contributing factors, already existing conditions and complications, providing a source of supporting evidence.

Medical professionals must also be cognizant of the abbreviations, punctuation and symbols used within the codes, known as conventions.

Proper Coding is Essential

It’s critical that the proper coding is entered on reimbursement requests and that a practice’s billing and coding specialist is well versed in their craft. Codes that don’t match the diagnosis or procedures taken will be delayed, denied or questioned as to the medical necessity of the action taken. Even simple mistakes will severely interrupt a clinic’s cash flow.

How to Minimize Your Accounts Receivable

How to Minimize Your Accounts Receivable

Accounts receivable is one of the biggest problems for private practices. Across the nation, there’s millions of dollars that practices are still waiting to collect from insurance companies. The problem is twofold. Practices aren’t using integrated software that performs automatic functions and many billers are being forced to enter each bit of data manually. That leaves them less time to concentrate on collecting from payers.

To remain financially secure, clinicians must do everything they can to shorten the revenue cycle for each patient and get paid faster. That means streamlining the biller’s job with software that contains automation and one-touch functionalities, along with scrubbing and editing abilities. Next to the clinician, a biller is the most important person in a practice. They’re highly trained professionals that keep revenue flowing into the practice.

Accelerated Submissions

In Touch EMR™ and In Touch Biller PRO are the two most advanced software systems available. The integrated systems work together to provide billers with tools that facilitate the entire billing process from start to finish. Efficiency is extremely important in today’s economic climate and In Touch EMR™ allows practitioners to create a claim and submit it to the biller by the time the patient leaves the office.

The system contains essential time-saving features that notify billers of potential problems that could delay the claim, such as incompatible CPT codes. If an inconsistency exists, billers can edit the claim as needed. The claim is automatically optimized, batched and sent the same day. The biller doesn’t have to manually load and send.

Where’s The Claim?

A critical part of the biller’s job is to track, monitor and follow up on submitted claims. In Touch Biller PRO enables billers to track each claim at every stage of the process. The software tells billers exactly where the claim is and its status, an ability that’s missing in most systems, but one that allows billers to track and process claims seamlessly.

The system automatically posts ERAs to patient accounts without the need for billers to do the task manually. That one ability alone provides an enormous time savings that can add up to $1,200 or more per month and thousands each year.

Next t to the clinician, the biller is the most important person in a practice. Any opportunity to streamline his/her job with automation should be implemented. In Touch EMR™ and In Touch Biller PRO makes the biller’s job easier, shortens the revenue cycle and allows practitioners to get paid faster.

What to Look for in Billing Reports

What to Look for in Billing Reports

Billing is the cash flow engine of the private practice. It should be simple, streamlined and efficient. Billing software can be used to check patient eligibility and post ERAs, along with sophisticated functions that include scrubbing claims, posting payments and billing secondary insurance with the click of a button.

Perhaps one of the most important functions is the ability to generate detailed yet simple reports. Such reports offer clinicians the means to determine if billers are being as efficient as possible and provide them with an accurate overview of the practice’s financial health.

Utilizing Metrics

An aging report provides a wealth of information. It shows therapists how much money that’s owed but hasn’t been collected. Practitioners can look up accounts receivable by payer and break it down utilizing a variety of different metrics ranging from location to procedure.

Practice owners can ascertain which payers reimburse slowly and providers that aren’t billing as much as others. Reports can be created by ICD and CPT codes to discover which procedures earn the most for the practice and which patients generate the most revenue. In Touch EMR™ has the ability to generate reports with sophisticated measures and customization options.

Data And Proofs

In Touch EMR™ provides clinicians with the ability to know exactly where their money is. They can do it themselves without waiting for the biller. Reports can be created for a week, month or even the last six months. The reports can be taken to the biller or the payer if needed. In Touch EMR™ enables practice owners to view their practice from a higher level and gives the clinician ammunition to address payment issues.

The reports provide therapists with the data needed to address biller problems and expedite the billing process. In Touch EMR™ reports show practitioners where potential problems exist and the point of origin. Therapists may find that they need to stop doing business with specific payers and providers.

It can take an average of a month to collect from insurance companies, but clinicians should be aware that it can take longer when working with Workers’ Compensation, out-of-state clients and auto accident claims. Clinics that experience a lot of these types of claims should be aware that the revenue stream may be delayed through no fault of the biller or provider.

The power and potential of In Touch EMR™ provides clinicians with valuable metrics and tools to diagnose the health of their practice and if the billing department is doing a good job. The integrated system gives practitioners the ability to create their own reports independently of the billing department. In Touch EMR™ gives practice owners the tools to run their lifestyle, not a system that runs them.

 

How to Bill More Efficiently

How to Bill More Efficiently

Quick and efficient billing is a necessity in today’s economic climate. Reduced reimbursements and changes brought about by Obamacare are forcing practices to work smarter and more efficiently to collect the revenues they’re due. The best way to accomplish that goal is through integrated software systems with automatic features.

In Touch Biller PRO has advanced features that allow billers to submit claims that are far less likely to incur a rejection and to submit those claims quicker. In Touch Biller PRO is a completely integrated scheduling, documentation, billing and marketing system available in a single product to shorten the revenue cycle.

Sophisticated Functions

With an integrated system, scheduling and documentation should work with the billing software with no need for a separate system. In Touch Biller PRO is designed to communicate with other systems for a seamless solution that carries data through to wherever it’s required. The biller is the most important person in a practice after the clinician and In Touch Biller PRO allows the biller to do his/her job more efficiently to keep funds flowing into the practice. Making the biller’s job easier means more revenue.

Automatic Data Entry & Tracking

In Touch Biller PRO eliminates manual entry of patient data that’s time consuming and robs billers of valuable time that can be better spent tracking and monitoring payments and claims. The software detects potential problems and inconsistencies and allows billers to edit claims before they’re submitted, a feature that’s lacking in other systems. Claims are scrubbed and optimized before they ever leave for the clearinghouse.

Customized Reports

The ability to generate sophisticated reports is an essential means of increasing income and determining the health of a practice. In Touch Biller PRO can produce customized reports whenever needed, based on a comprehensive array of criteria. Reports can be generated according to accounts receivable, ICD and CPT codes, payers, providers and referral sources.

To keep revenues high, practitioners require a system with seamless integration, the ability to edit claims, and generate sophisticated reports using multiple criteria. In Touch Biller PRO provides billers with essential tools to shorten the revenue cycle and offers clinicians multiple ways to diagnose the health of their practice.

The Revised CMS-1500 Claim Form

The Revised CMS-1500 Claim Form

The transition to ICD-10 codes comes with a revised CMS form to facilitate reporting. The National Uniform Claim Committee (NUCC) approved the use of the revised CMS- 1500 Claim Form in February 2012. The new CMS-1500 form will be printed with 02/12 in the lower right hand corner to indicate it’s the replacement for the 08/05 version.

The CMS-1500 must be used when billing Medicare and other federal payers for services. Clinicians must indicate when submitting claims on CMS-1500 if they’re using ICD-9 codes or if they’ve already made the transition to ICD-10. It’s essential that clinicians maintain communication with their payers and clearinghouses and conduct testing to ensure submissions are being transmitted and received correctly.

Medicare began accepting the revised version of claim form CMS-1500 on Jan. 6, 2014 and all submissions after March 31, 2014 must be done with the revised CMS-1500.

For those who have received a waiver for electronic transmission, Medicare will continue to accept paper claims, but only on the revised form. Medicare will deny any claim submitted on the old CMS form on and after April 1, 2014.

The new CMS-1500 was required to correctly report and document the thousands of new ICD-10 codes and the alpha-numeric system that will be used. Use of the new form is mandatory when billing any federal payer. Many of the line-by-line item changes were relatively small, such as changes in wording. For example, TRICARE CHAMPUS has been shortened to TRICARE and the Social Security number is now referred to as an ID number.

 

Other line items with which clinicians were familiar were eliminated entirely, since the information will now be reported elsewhere on the form or not at all. A number of lines now read “Reserved For NUCC Use” and data that includes employer’s name, school and balance due that wasn’t reported on 837P weren’t deemed necessary and aren’t required on CMS-1500.

An enhancement on the form allows clinicians to list up to 12 diagnosis codes per patient. CMS-1500 has a number of open fields, but they can’t be utilized to report additional data. Practitioners now have qualifiers to identify them as a referring, ordering or supervising provider and diagnosis codes that were labeled 1-4 now have an A-L designation.

The ICD-10 codes are more specific and the CMS-1500 reflects that. The new form has a QR Code that can be scanned with a smartphone. The QR Code takes users to the NUCC website. The revised CMS-1500 also underwent changes that would provide practitioners with the ability to add extra qualifiers when needed.

Any reimbursement claims filed prior to implementation of the revised CMS-1500 that must be resubmitted for any reason should be transmitted utilizing the revised form. This is true even if the previous claim was submitted on the earlier form.

A copy of the form can be downloaded for examination purposes, but it can’t be utilized to submit claims. CMS-1500 uses exact red ink match technology and much of the embedded information will remain invisible when it’s scanned with an Optical Character Recognition (OCR) device. Clinicians should be aware that payers can opt not to process claims that are submitted in black ink and doesn’t use the red ink match technology.

It will take some time for clinicians to familiarize themselves with the revised CMS-1500 form and the new ICD-10 codes, but the form is now an accomplished fact. The new codes and forms are a reality of the healthcare environment and clinicians must use them or risk not receiving reimbursements.