On October 1, 2014, all health care providers will switch from ICD-9 coding to ICD-10 coding when they bill private insurance, Medicare and Medicaid . To understand how large this move is, there are only 20,000 ICD-9 codes while the number of codes in ICD-10 set is nearly 70,000.
Healthcare finance officials disagree on whether the new coding will increase or decrease initial denials. It is clear that when the October 2014 deadline comes, provider productivity will see an initial drop in due to denial of claims that will eventually drop off to similar levels existing today. However, denial management will become easier as the increased specificity of the ICD-10 classification system makes it easier to code correctly and also to correct denied claims. Nevertheless, one study estimates that small practices will suffer a decrease in productivity from $8,500 to $20,250, and medium practices will suffer productivity decreases of $72,649 to $166,649. Large practices can expect productivity losses from $736,487 to more than $1.5 million.
To succeed in making the transition to ICD-10 denial management as painless as possible, the process for claims denial management cannot wait even one day more.
Advantages to patient care and disease will be a derivative of ICD-10 coding because of its specificity, but many providers are viewing implementation just as everyone with a computer system fretted over the never seen Y2K disaster. If you are in this category, you should worry as time is running out.
How to Mitigate Losses From Implementing ICD-10
Awareness and preparation are the keys to mitigating losses from delayed and denied payments. Break the denial management process into smaller pieces so that no task is overwhelming. When your billing function is properly prepared in terms of people, processes, and technology the better prepared your practice will be in responding to changes that are coming.
- Begin with people. The new coding will affect everyone in the practice, including physicians, nurses, and registration and appointment personnel and billing staff including coders. Existing now are curricula ready for deployment far in advance of the October 1, 2014 implementation date.
- Begin planning for hiring your ICD-10 trained coders now. There will be more jobs than qualified coders, so hire now. The sooner you hire the sooner you have another resource to use in training your staff.
- Medical practices with a strong claims denial management process in place are already learning the root causes of denials, determining gaps in your processes and are taking corrective action.
- Make process changes now for ICD-coding denials that give you the ability to determine if a denial is related to ICD-10. Already, many codes cross over from ICD-9 to ICD-10. Denial crosswalks and other processes that address cross over coding before filing a claim can be a substantial help in lowering ICD-10 risk.
- It is important that the practice knows which current tools and processes must change before the transition is finalized. Simple fixes go a long way towards reducing denials. Simple changes may include changing field length and alpha character acceptance. Changes that are more difficult require more data hooks for comprehensive financial and clinical analysis.
- Dealing with ICD-10 implementation calls for thorough, trended reporting of financial metrics. From these reports, practices can learn details of ICD-10 coding denials, as well as resolve many of the conflicts that arise from mammoth changes in a reimbursement system.
The beauty of a claims denial management system is its ability to point out “hot spots” in your claims filing process. A sound claims denial management system looks at everything and reports to you quantitatively at where you have gone off-track. It may be wrong registration data – incorrect ID number or leaving out the gender. Or, insurance could deny a claim if it the ICD code is not specific enough.
RevenueXL is a company that works with medical practices ranging in size from solo providers to large group practices. We have solutions for claims denial management ranging from complete software solutions, workflow analysis and solutions for electronic medical records, medical billing, medical coding, coding audits, and denied claims management. Call RevenueXL now at 888-461-9998 to learn how we can help you prepare for ICD-10 implementation.