Self-Pay Revenue Management

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October 1, 2015. ICD-10: Game On

September 9, 2015 - 6:01 PM

October 1, 2015, did it come too soon? A deadline dictated by unwise policymakers? Our opinions differ. But, agree or not, the time has come.

So that being said, where do we start?

The promise of the oft-postponed ICD-10 is that its increased number of characters (three to seven in ICD-10 versus the previous three to five in ICD-9 CM, three to four numbers in ICD-9 procedure codes to seven alphanumeric characters in ICD-10 PCS) will provide for new technologies and diagnoses as well as markedly enhanced specificity in both coding and procedures. Greater granularity should provide improved quality of care, substantial improvement in clinical research and notable amplification in population health management.

Make a Plan
– Obtain access to ICD-10 Codes.
– Decide the role your clearing house will play in your transition.

Train your Staff
– Train staff on ICD-10 fundamentals (There is a lot of free resources from CMS)
– Identify top codes. What codes does your practice use most often. Drill your training towards those codes.
– Flag situations where more documentation will be needed.

Update your Processes
– Update hard-copy and electronic forms.
– Resolve documentation gaps
– Make sure your clinical documentation captures the new coding concepts

Talk to your Vendors and Health Plans
– Confirm your health plans, clearing houses and third party billing services are ICD-10 ready. (Get it in writing)
– Ask these parties about testing results.

Test your Systems and Processes/Verify your system is ready to:
– Generate a claim
– Perform eligibility verification
– Schedule office visits
– Schedule outpatient procedures
– Submit quality data
– Update patients history and problems
– Code a patient encounter

Test your system with partners, vendors, clearinghouses, billing company and health plans.

On a scale of 1-20 how prepared are you for the upcoming changes? We’re less than 60 days away from this being implemented; unless they decide to push this back even further.

-Audrey Cooper

Related Links:
Emerald A/R Systems Website
Emerald A/R Systems LinkedIn Business Page
Emerald A/R Systems Facebook, Twitter.

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