Should a practice outsource medical billing to prepare for icd 10 challange

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Should a Practice Outsource Billing to Prepare for

ICD-10 Challenge?

We will be tweeting live @Ken_Edwards01

#CureMDWebinar

Presenter

Ken Edwards Senior Billing Manager, CureMD

Topics to be covered

. . . . .

Impact of ICD-10 Vendor Readiness Practice Readiness Outsourced vs in-house billing What to look for in an ideal RCM partner for ICD-10?

ICD-10

Q. What is your top most concern for ICD-10? a. Physician documentation post ICD-10 b. Readiness of billing department c. Readiness of your EHR vendor

ICD-10 changes EVERYTHING

. .

The change that will shake the healthcare industry Claim errors will increase by 7%

Revenue and cashflow impact of ICD-10

.. ..

40% increase in A/R days (CMS) 200% rise in claim denial rates (CMS) Justify the medical treatment Complex denial appeals

Source: Centers for Medicare and Medicaid Services

Scenario 1 Vendor Readiness

What should you ask your current vendor?

Will your products be ready for the ICD-10 compliance date?

ICD-10 Readiness

Will both your EHR and practice management system solutions be able to support ICD-10?

When will you be able to show me how ICD-10 will work in my EHR and practice management solutions?

Will your system support both ICD-9 and ICD-10 codes?

Cost

How much will you charge to upgrade to the new ICD-10-compliant solution?

Does training cost extra?

Will I need new hardware to accommodate your ICD-10 upgrade ?

Implementation

Will you help me test my ICD-10 compliant EHR and practice management system with my payers?

What is your time frame for implementation?

What tools, training, and support will you provide to me and my staff so we can prepare our practice for ICD-10?

If your EHR Vendor does not respond in a timely manner

or

if the responses you receive are vague

Consider Switching

Scenario 2 Practice Readiness

Are you up for the challenge?

ICD-10 will have a direct impact on physicians through:

. . . .

Physician quality profiles – mortality and morbidity Physician utilization profiles – efficiency of treating patients Physicians’ current and future evaluation and management levels, including pay for performance Daily workflow – (if ICD-10 is not properly implemented)

It is estimated that physician productivity will decrease by

10%-20% due to ICD-10 documentation

ICD-10 will infiltrate your domain

Physicians

Clinical Area Managers

Nurses

Lab

Front Desk Billing

Coding

Source: American Academy of Professional Coders

Is your Billing department up for the challenge?

1..

Benchmarking important KPIs

..

Where do your denials stand?

Denials > 4% = poor performance Cost per denial = $30 Adm

Pati

ent

care

inis

trat

ive t

ime

2.

Started training coders?

16 hours on ICD-10-CM

24 hours on ICD-10-PCS 10 hours on practice implementations (AHIMA)

Source: American Health Information Management Association

3. .

Hiring in-house billers?

Professional coder costs $50,000

4. .

A/R management?

. .

Exceed 120 days Periodic reports Specialty-level comparison

5.

Resources for PQRS and MU Stage 2?

Is your practice on track ?

2014

2015

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

D E A D L I N E

PLANNING Identify resources Create project team Assess effects Create project plan Secure budget COMMUNICATIONS Inform staff Contact vendors Contact payers Monitor vendor prep Monitor payer prep

O C T

TESTING High-level training for test team Level 1: internal Level 2: external COMPREHENSIVE TRAINING Documentation Coding

Oct

1

Ongoing practice before “go live” Ongoing practice before “go live”

2 0 1 5

Nov

Dec

If your practice is not prepared for ICD-10 Consider Outsourcing!

In-house vs outsourced In-house

Cons

Retain Control Close Proximity

Liabilities Sta issues Higher costs

Outsourced

Pros

Less Expensive Transparent Enhanced Consistency

Hands o Hidden Fees

Fact 6% increase in revenue for practices with outsourced billing.

Nearly 90% of solo and small practice physicians with in-house billers and collectors said they expect to outsource most or all their billing functions for ICD-10.

Source: Black Book Rankings Survey 2014

Choose the right billing vendor

. . . .

Do not select a billing company solely on low rates without considering the risk attached to it Before outsourcing billing and collection services, practices should carefully evaluate the company to minimize risk and lost revenue.

Make sure your billing service provides you with a HIPAA-compliant Business Associate Agreement—and read it carefully.

Don’t assume that billing service employees are up-to-date on federal regulations; ask about employee training.

Don’t seal the deal with a handshake; make sure you have a contract that spells out the terms of service and includes details on indemnification, insurance, and termination.

What is your strategy for ICD-10 so far? a. Go at it alone b. Outsource to a billing company c. Bring an ICD-10 consultant on board

CureMD Value Proposition

Billing Service ICD-10 consultation team ICD-10 ready software We updated our cloud-based EHR in 2014, giving our providers ample of time to practice new codes before the deadline.

Our in-house experts will assist you throughout the conversion process, helping you with training and successful implementation of ICD-10.

Still anxious about your prospects for successful ICD-10 conversion? We have a perfect solution for you. Give us your medical billing and concentrate on your patients.

QA &

Session

Need Help?

Request a demo to see how CureMD can facilitate your practice for ICD-10 Get in touch with our ICD-10 experts at (212) 852 0279 ext 384 For further inquiries regarding ICD-10, send us an email at healthit@curemd.com

Thank you

Look out for our email, containing the webinar recording and free ICD-10 ebook