Receiving a flurry of bills for months after any medical procedure has become commonplace for patients, and it’s safe to say that most don’t like it. In fact, a patient’s satisfaction drops by about 10 percent after receiving a bill for services, thanks to the confusion and waste involved, according to MedCity News. Implementing claims technology to streamline bills can not only make things easier for patients, but might ease the paperwork and costs for the physician’s practice as well. But where to begin?
There are numerous ways a practice can adopt claims technology and not break the bank. One good option is focusing on technologies that are similar to those already in place, so a software change might not be necessary. Look for claims technology that ties in with patient portals, online claim tracking, smartphone apps and the like. Transparency can also make a difference: Competitive Electronic Marketplaces give the patient an opportunity to choose from a variety of options, allowing for price comparisons, transparency in costs and the ability to “shop around” to get the best deal.
Why now is a good time for change
With all the changes that have come to healthcare over the past few years, claims technology might seem like just another change that physicians don’t have the time to make. But now is actually the perfect time, thanks to even more changes coming in the months ahead.
On October 1, 2014, physicians will be expected to shift from the old International Classification of Diseases, 9th Edition — commonly known as ICD-9 — to new ICD-10 coding. When this shift takes place, the number of diagnostic codes available to healthcare providers increases from the current 13,000 to well over 68,000. This means in-depth education, training and testing for personnel, who are already adapting to the variety of changes brought about by electronic health records.
The result could be a perfect storm of problems, especially considering that only one of every 10 practices had made significant strides toward the new implementation, according to Medpage Today. But it could also be an opportunity. These changes are definitely coming, so it’s time to take a deep breath and prepare for the overhaul.
How to Prepare for ICD-10
With time running out, how can physicians catch up to the changes that will come about in October? Jennifer O’Brien of Karen Zupko & Associates, a Chicago-based physician practice management consulting firm, offers tips for those who need to speed up their transition to ICD-10.
It starts with preparing for the financial impact that will be felt in the fourth quarter of 2014. O’Brien suggests planning to secure a line of credit that will cover all necessary operating expenses for three to six months. Assume the worst-case scenario of no third-party payments for the final quarter of 2014. To compensate, self-employed physicians should cut their salary by 25 percent through the first three quarters of the year to allow a cushion of payment in the last quarter.
In addition to preparing for the financial hit, physicians should look at how they will actually make the transition. O’Brien offers a plan based on the “Four T’s”:
- Team. “Establish a work group for the ICD-10 conversion,” O’Brien said. “The group should plan on meeting weekly. Someone should create and maintain a single work plan that lists tasks, dates and who is responsible.” Include at least one physician, billing and coding specialist, clinical assistant, practice manager and representatives from other areas of the practice that regularly use diagnostic codes.
- Testing. “Communicate with your EMR, practice management software vendor, clearinghouse and biggest payors as to if, when and how testing of claims with ICD-10 will be done,” O’Brien said. “Most practices submit claims through a clearinghouse…the practice needs to follow up with the clearinghouse after testing to see how it went.”
- Training. Now is the time to get familiar with the changes. “Practices should contact local and national medical and specialty societies to see what ICD-10 training is available for physicians and staff,” O’Brien recommended. “Doctors will need to learn ICD-10 coding so that the documentation such as chart notes and operative reports adequately supports the ICD-10 codes submitted. Other organizations that may have ICD-10 training available are practice management software companies, hospitals, the AAPC and AHIMA.”
- Tools. O’Brien recommends the book “ICD-10-CM Mappings 2014,” published by the American Medical Association. “Practices will need to make sure their PMS and EMR systems are loaded with ICD-10-CM codes and will need to order ICD-10-CM books,” she said. Once that is done, “run a list of your 25-75 most common ICD-9-CM codes and ‘crosswalk’ them to ICD-10-CM. Expect a one-to-multiple crosswalk rather than a one-to-one.There are likely to be many ICD-10-CM codes for each ICD-9-CM codes.”
Between the recent move to electronic health records, the push for claims technology and health payment systems, and the move to ICD-10 right around the corner, physicians and their staff might feel overwhelmed. But getting started right now can mean the difference between a smooth transition and a mad scramble to meet deadlines. Prepare for the ICD-10 changes, and at the same time, implement new claims technology that will result in a streamlined, easy payment system — one that is suitable for both physicians and their patients.