Medical Billing Coding, Medical Coding Service, ICD-10

ICD-10 Implementation, New Features, Benefits, and Our Plan of Action for Internal Medicine Web: www.vocisinc.com Sales: 866 365 3909 Email: contact@vocisinc.com

ICD-10-CM/PCS COMPLIANCE DATE 

Implementation scheduled for 1st October 2014



Testing of these codes starts effective January 2014

BENEFITS OF ICD-10-CM 

ICD-10-CM incorporates much greater clinical detail and will be more specific than ICD-9-CM.

For example : ICD-10 for Right knee pain-M25.561 and Left knee pain-M25.562 where as ICD-9 for Right or Left knee pain – 719.46 

Reducing the need for attachments to explain the patient’s condition



Improving clinical, financial, and administrative performance



Preventing health care fraud and will be more informative



Once coding is completed , ICD-10 makes claim submission more efficient

Difference

ICD-9

ICD-10

Consists of 3 – 5 characters

Consists of 3 – 7 characters

1st character is alpha or numeric

1st character is always alpha

Shorter code description as not specific and abbreviated codes

Longer code description as more specific and detailed codes

13,600 codes

69,000 codes

Eg. Rotator cuff sprain and strain is Eg. Rotator cuff sprain and strain is 840.4 S43.429A Eg. Hip Pain : 719.45

Eg. Hip Pain : M25.559

Eg. Rotator cuff sprain and strain is Eg. Rotator cuff sprain and strain is 840.4 S43.429A

ICD 9

DIAGNOSIS

ICD 10

Hypertension Hypertension, unspecified

401.9

I10

Hypertension, uncontrolled

401

I10

DM type 2

Diabetes 250

E11.9

DM type 1

250.02 250.01

E11.65 E10.9

DM type 1, uncontrolled

250.03

E10.65

DM type ii, Uncontrolled

Neoplasm Malignant neoplasm, lung

162.9

C34.90

Metastatic neoplasm liver

197 212.3

C78.00 D14.30

Benign neoplasm, lung

Frequently Used Codes – VOCIS observation VOCIS checked the documentation for the most often used codes in your practice

Diagnosis

ICD 9

ICD 10

Hypertension

401.9

I10

Chronic pain syndrome

338.4

G89.4

Congestive heart failure

428.0

I50.9

Long term medication

V58.69

Z79.899

Fatigue

780.79

R53.1

Constipation

564.00

K59.00

Allergic rhinitis

477.9

J30.9

Back pain

724.5

M54.9 Continued‌

Diagnosis

ICD 9

ICD 10

Diabetes - Type II

250.00

E11.9

Hyperlipidemia

272.4

E78.5

Degenerative Disc Disease Lumbar Spine

722.52

M51.36

Anxiety

300.00

F41.9

Depression

311

F32.9

Chronic pain

338.29

G89.29

Anemia

285.9

D64.9

Atrial Fibrillation

427.31

I48.91

Coronary Artery Disease

414.00

I25.10

Cerebral Vascular Accident Degenerative Disc Disease Cervical Spine

434.91

I63.50

722.4

M50.30

Hypothyroidism

244.9

E03.9

ICD-10 impact on Revenue Cycle Management

VOCIS anticipation 

Delayed reimbursement from government during ICD-10 implementation as this is in the transition phase, some delays can be expected



Account Receivable days may increase by 20 to 40 percent post implementation through a transition period



As per survey “Workgroup for Electronic Data Interchange” (WEDI) – (the leading authority on the use of Health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency and to reduce costs of the American healthcare system)

estimates that rejection and denial rates may increase by 100 – 200 percent during the same period

Continued…

VOCIS Plan of Action 

We have already started training for our staff on ICD-10 implementation via attending Webinars and trainings arranged by AAPC



Will keep educating the Providers on the updates and changes for ICD-10 implementation



ICD-10 codes is already imported in the billing software so that the testing can be started at the earliest and to get familiar with new codes – Testing starts effective Jan 2014



Generally we accept 45-60 days in AR as quite reasonable, but we would have to be more aggressive , more goal oriented. In actual words its time to challenge the process



VOCIS planned to focus on the AR a bit early so that the

denials can be captured on time and can be worked accordingly. This will fasten the payment process.

Continued…





Few of the AR reporting will help to manage the accounts 

Zero to 30 days, separated by payer



Daily and weekly revenue



Outstanding days

Insurance verification for all the patients/accounts will be checked before billing the claim to insurance.

This will ensure that we are billing the claim to the right insurance and will speed up the payment process and at the same time will reduce the denials

Additional Information 

New claim form/CMS-1500 named 02/12 form (sample on next page)will be used, with more columns to add the ICD-10 codes which results in more accurate payment flow from the insurance side



The current claim form/CMS-1500 has the limitation of using only 4 ICD-9 codes



During the training period we will bill ICD-9 and ICD-10 simultaneously to the insurance on the same claim form to ensure that we are billing correct codes



The version 02/12 form will likely be accepted by Medicare in January of 2014, but providers can still use the old forms until April 1, 2014, when only the 02/12 form will be accepted

Suggestions -

Important for Providers



Providers will need to improve documentation because unless they are as specific as possible, coding staff will never be able to assign the right code which might lead to billing complications



Front desk should always discuss the patient responsibility before treatment and COPAY should be collected on the day of service also patient should be informed of the left over balance after the insurance pays : will be Patient’s responsibility



ICD-10 implementation may require the need for financial back up OR line of credit to offset cash flow challenges due to government glitches Continued…

NEW FEATURES IN ICD-10-CM 

Laterality (Left, Right, Bilateral)

Examples:





C50.511 – Malignant neoplasm of lower-outer quadrant of right female breast;



H16.013 – Central corneal ulcer, bilateral; and



L89.012 – Pressure ulcer of right elbow, stage II.

Combination Codes For Certain Conditions and Common Associated Symptoms and Manifestations

Examples: 

K57.21 – Diverticulitis of large intestine with perforation and abscess with bleeding;



E11.341 – Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema; and

Continued…



Character “x” is Used as a 5th Character Placeholder in Certain 6 Character Codes to Allow for Future Expansion and to Fill in Other Empty Characters (For Example, Character 5 and/or 6) When a Code That is Less Than 6 Characters in Length Requires a 7th Character

Examples:





T46.1x5A – Adverse effect of calcium-channel blockers, initial encounter; and



T15.02xD – Foreign body in cornea, left eye, subsequent encounter

Inclusion of Clinical Concepts That Do Not Exist in ICD9-CM (For Example, Underdosing, Blood Type, Blood Alcohol Level)

Examples: 

T45.526D – Underdosing of antithrombotic drugs, subsequent encounter;



Z67.40 – Type O blood, Rh positive; and



Y90.6 – Blood alcohol level of 120 – 199 mg/100 ml.

Continued…



A Number of Codes Are Significantly Expanded (For Example, Injuries, Diabetes, Substance Abuse, Postoperative Complications)

Examples: 

E10.610 – Type 1 diabetes mellitus with diabetic neuropathic arthropathy;



F10.182 – Alcohol abuse with alcohol-induced sleep disorder; and



T82.02xA – Displacement of heart valve prosthesis, initial encounter

Who We Are 

In 2000, A group of Healthcare Industry veteran talents teamed up to launch, 'Vocis', an organization with a difference, that specialized in making medical groups more competitive for today's world



Advised and owned by Physicians



A BBB Accredited; Practice Management Company based in Louisville KY, involved in Medical Credentialing, Billing, Collections, Transcription, Practice Marketing, Virtual Receptionist, and Practice Set up for independent NPs, PTs, and MDs



Successfully providing services to over 150 satisfied customers all over US



Experienced team of AAPC Certified Coders, Billing Specialists, AR Analysts, Denial Management Specialists, Quality Analysts and backed by experienced team of Software, Network and Hardware Engineers



State-Of-Art IT infrastructure center comprises of HP PCs, High speed internet leased line with assured 24/7 connectivity, Network & Server monitoring, Data Back-up & Remote storage facility and 100% power back-up

We Offer 

Fee Schedule Review and Analysis



Eligibility and Benefit Verification



Assistance with Provider Enrollment



Electronic and Paper Claims Submission



Account Receivables



Secondary Insurance Billing



Inbound/Outbound calling



Worker’s Comp and No Fault

Web: www.vocisinc.com Sales: 866 365 3909 Email: contact@vocisinc.com



Patient Demographics Entry



Authorization Request and Tracking



Charge Entry – All Specialties



Posting of Insurance and Patient Payments



Patient Statement



Denial Review and Management



Customized management reports



Medical Coding

Pricing The pricing structure for VOCIS’s billing and coding services is straightforward, and calculated as a percentage of your organization’s monthly net collections. To the contrary, the pricing is determined by a detailed analysis of your organization’s key characteristics, finances and other data.

“We charge just amount”

4 to 8% of collected

Contact Us Sales 866 365 3909 General Information Phone – 502 638 4285 Web – vocisinc.com Email – contact@vocisinc.com