Impacts from ICD-10 Medical Coding on Reimbursements

Posted by Ecareindia on March 4th, 2015

The latest buzz in the US healthcare space is the impending ICD-10 medical coding transition that is about to take effect on October 1, 2015. Although the preparation for implementing ICD-10 diagnostic and procedural (PCS) codes has started long before, the situation has intensified in recent times due to the fast-approaching deadline. This switchover is not going to be easy on the Providers or medical billing companies. However navigating through these challenges, while providing high-quality customer services, would be the best option for billing companies. To overcome these challenges, let us first learn what impacts are likely to be caused on reimbursements by the ICD-10 medical coding transition:

More Codes! More Time! An inclusion of approximately 200,000 new codes to the existing code set is completely going to change the way how coding will be done from Oct ‘15. As the complexity of coding increases, the time taken to code each chart will also increase. Consequently, coders will be under pressure in finishing their medical coding services before the intended deadlines.

Training: Working with the new codes without proper skill sets can lead to error-prone claims, thereby affecting the reimbursements badly. Therefore, the coding staff must be provided with proper training on the ICD-10 medical coding techniques and nuances. In addition to implementation, the US healthcare entities will require to spend on staff training as well.

Claim Denials: The prime reason for claim denials is improper coding and lack of auditing. With 200,000 new codes in the offing, usage of appropriate codes and modifiers would be truly challenging. There are very high chances that the collections would face a big hit. However, experienced offshore vendors can keep you off the burden of denial management and help billing companies focus on the primary goals of customer satisfaction and sustaining profitability.

AR Pile-up: During the course of training, coders will be busy learning the new techniques and hardly find time to take care of the present medical coding services. After training, we cannot expect them to give their 100%, as the transition passes through the learning curve phase. In the initial stages of implementation, there would be an increase in claim denials, inflating the AR and affecting reimbursements. A lot of AR effort will be required and the revenue spent on cleaning the pile-up will also be more. The ideal solution would be to outsource to an experienced offshore medical billing company that will take care of the denial management.

Other Healthcare Changes: With the introduction of other changes like healthcare exchange marketplace, ACO (Accountable Care Organizations), etc., the responsibilities and efforts of medical billing companies have increased in handling the billing for Providers. Therefore, the time for performing correct billing is highly affected resulting in revenue loss.

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About E-care India:

E-care India has 15 years of experience in the industry. E-care’s 3 offshore medical billing delivery centers have been providing end-to-end medical billing, denial management and medical coding services seamlessly to its clients. To know more about e-care and its services, log on to www.ecareindia.com