Should a Practice Outsource Billing to Prepare for ICD-10
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Transcript of Should a Practice Outsource Billing to Prepare for ICD-10
Outsource Billing to Ready for ICD-10
• Every practice across the country will send out claims based on ICD-10 codes starting October 1, 2015, if they want to get paid for services rendered.
• The updates are massive, as will be the adjustments you’ll need to make to meet this challenge.
• Are you equipped for these workflow changes?
• And is Outsourcing your medical billing only way forward ?
Outsource Billing to Ready for ICD-10
• The following presentation will identify the medical billing challenges a practice faces, and if your practice needs to outsource medical billing to prepare for the ICD-10 challenge.
• Periodically benchmarking certain key performance indicators (KPIs) against industry and specialty-based averages is a tried and tested method of determining what the “better performers” are doing to earn more.
• Here are a few you should test:
Outsource Billing to Ready for ICD-10
1. A/R exceeding 120 days
– The time it takes to get paid for your claims must be provided by your billing team via monthly insurance aging reports.
– A MedicalGroupManagementAssociation (MGMA) benchmarks the 120-day aging bucket for different specialties.
– Compare the MGMA percentages for your specialty with the results at your practice to find if the A/R at your practice is collected slower or faster than the industry average.
Outsource Billing to Ready for ICD-10
2. Cost of appealing denials
– “Cost to appeal denial” by The Verden Group’s CEO Susanne Madden found that appealing an average of 16 denials out of 200 claims/month would cost your practice $7,680/year in time and resources; with each appeal costing $40.
– Dig deeper into this KPI, as your practice could be losing a lot more on appealing denials.
Outsource Billing to Ready for ICD-10
3. Patient Collections
– The best practices send out only two statements for collections, while other practices send 3-5. They also send lesser letters and make fewer phone calls for collections. Which category does your practice belong to?
– Assessing these KPIs will help you gauge your billing team’s productivity, as inefficiency lowers revenue.
– And while these are problems you’re already dealing with, here’s what ICD-10 will bring:
Outsource Billing to Ready for ICD-10
• ICD-10 codes will be complex
– With about 155,000 diagnosis and procedure codes in ICD-10 replacing approximately 14,000 ICD-9 codes, the dynamics of Medical Billing at every practice will change.
– Not only are there a lot more codes that medical billers will need to learn, they are also on a lengthier and more complex format.
Outsource Billing to Ready for ICD-10
• Preparation and impact of the ICD-10 conversion on billing
– Getting paid for claims will require a lot more effort with all these new codes, and this will add up to the existing issues that your billing team is facing.
– Moreover, the conversion will require:
• An implementation team
• Internal awareness and training
• External communication with partners (to assess readiness of EHR vendors, insurance, clearinghouses)
• Internal and external testing of the new codes
Outsource Billing to Ready for ICD-10
• The challenge of transitioning to ICD-10 for every practice will be huge, but the impact will vary based on your current billing methods, preparation for the transition, and the billing team you’ve employed.
• Many are switching from in-house billing departments to professional third-party outsourcing, for efficiency, consistency and security.
Outsource Billing to Ready for ICD-10
• Others are dedicating resources to train their team for ICD-10. However, getting all of this done before October 1, and ensuring that your payments aren’t affected in the process will be a huge challenges
• But what’s best for you depends on the current revenue cycle management processes deployed at your practice.
Read more on blog.curemd.com
• To read more on this topic, visit:
• http://blog.curemd.com/should-a-practice-outsource-billing-to-prepare-for-icd-10-challenge/
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