ICD-10 Changes from a Billing Agency's Point of View
By: Yvonne Dailey, CPC, CPC-I, CPB
For the past two years I have seen billing agencies close their doors for one of three reasons:
1. The cost to update their systems to accommodate the changes or
2. The provider was fearful that he or she couldn’t survive ICD-10 and sold the practice to the hospital, or
3. The provider took the billing in-house because he or she purchased an EMR.
As a coder and an owner of a billing agency, I took a different approach to ICD-10 and started to inform providers of the upcoming changes and how preparing early could assist in a grand way. Here are some of the areas we had providers take a look at:
- First, we started by doing crosswalks for their top diagnosis codes. Eighty percent of practice revenue comes from their 20 top diagnosis codes. Providers need to run a frequency report of those top 20 diagnoses and start to crosswalk them into the new ICD-10 code sets. By doing this, a practice can start to identify where to make changes to their documentation.
- Second, another area that will affect documentation is laterally. Although not necessary right now, we started two years ago requesting this information from our providers so when the time comes it’s like second nature to them to provide us with the information.
- Third, we reviewed all office documents requiring a diagnosis code. Some systems run their financial reports by diagnosis code. We took a look to ensure we were crosswalking the codes to be able to run the reports. We removed the diagnosis code from some statements and now only print the primary diagnosis code. One wouldn’t think that statements and reports change, but with the new codes come larger data fields; therefore some documents needed to be changed.
- Fourth, we reviewed payer contracts. Were any tied to a diagnosis code? If so how would that affect the documentation? What new information would be needed to captured to ensure no money is left on the table? We also review the dates of the contracts so provider could prepare to renegotiate if necessary.
- Fifth, if the provider currently had an electronic medical record (EMR), we started to review the templates and instructed them to review their contracts. With the new code changes all the system will need to be re-customized.
These were just some of the areas we looked at with our providers. On the billing end, we started to track and monitor the revenue cycle. We tracked the average time for reimbursement so that we would be able to set a benchmark once the changes take effect. With the changes for 5010 we found that the EDI reports were more detailed and that has helped allot as now we’re tracking areas that may be affected such as new claim edits for laterality.
A lot of the system requirements will be a large burden on the billing agency side, such as when and who will update the system for ICD-10. This required that we start our talks with our vendors early and, whenever possible, we volunteered to be testers. This keeps us ahead of the game with any changes or problems we may have.
We also took a moment to review our contracts with providers. If the provider’s documentation does not meet the necessary requirements for billing, how will we handle this as this will affect not only the providers’ cash flow but that of our office as well? Will we now provide coding services? Do we want to take on that liability? Will we pass some of the cost to the providers and if so how will do this with old clients? We also needed to offer an EMR to providers and learn the many different systems so that if a provider wanted us to bill on his system, we could generate our reports. We currently have a mixed batch of providers. Some on our EMR system, some on their own, and some still on paper. We had to learn how to roll with the punches but still give Grade A service.
I found by taking the approach to educate the providers and staff has helped us to remain open. I also found that being a certified coder also helped because with all the changes providers are now realizing the value of a coder to assist with all the changes.
I still feel we have a long way to go as some providers still feel the change won’t happen and are still procrastinating, but with the right guidance we can survive the changes and billing agencies will be able to stay open with a larger playing field.
The time to make changes is now and both the provider and the billing agency have to work together and stay proactive to avoid possible compliance issues later.