One of the areas that will be most impacted by the switch to ICD-10 will be the billing department. The ability of billing and coding staff to keep up with the increased coding requirements will have a direct impact on the continued flow of revenues to practices. Staff will need sufficient training in the new codes and even then, it may be necessary to engage additional personnel to address back logs.
After the deadline, any claims that aren’t submitted using ICD-10 will automatically be denied. Coding and billing staff will need the highest level of training available. People learn by doing and whenever possible, it’s a good idea to start using dual coding.
Practitioners that have their billing done by a professional agency will need to consult with the company to ensure the firm is prepared and revenues won’t be disrupted. Part of biller/coder readiness is ensuring that they and the software used is compliant with the strict HIPAA standards governing the electronic transmission of patient data.
Billers and coders may also need a refresher course in anatomy and physiology. The increased specificity of ICD-10 will require more in-depth coding. Billers/coders will find themselves using more specific terms than they’re normally accustomed. Next to the clinician, billers/coders are the most important link in the revenue chain. They must be ready for the transition or revenues will falter.,
Some interruption in the revenue flow will be inevitable. By its very composition, the new alpha-numeric coding system requires billers/coders to switch between a numeric pad and a keyboard, which will result in a slowing of coding claims. Super bills may no longer be a feasible option, requiring billers and coders to learn new forms and formats.
There are bound to be claims that are rejected in error due to the new coding. Claims will require resubmission and coders/billers will find themselves investing a significant amount of time communicating with clearinghouses and payers to determine why claims were denied. No matter how well trained the biller/coder is, those type of instances will slow down the submission and collection management process.
Errors in documentation and rejected claims will result in many patients receiving bills they don’t deserve. While it doesn’t directly affect billers/coders, it will have an impact on practices. Clinicians will see an increase in calls from panicked patients, requiring time and a cool head to explain and sooth clients.
Clinicians must adhere to coding guidelines if billers are to submit accurate claims. Practitioners can’t code for a suspected or probable diagnosis; items that would appear in notes must now be coded; coding should be done at the highest level possible; and a focus should be on medical necessity.
Clinicians and billers/coders have always had a partnership in terms of revenues and that relationship will be even more important as ICD-10 goes into effect. The billing department should be encouraged to seek verification and understanding of any item for which they’re unsure and clinicians should make time for this.