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ICD-10 Challenge?Should a Practice Outsource Billing to Prepare for
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#CureMDWebinar @Ken_Edwards01
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Presenter
Ken EdwardsSenior 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?
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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
The change that will shake the
healthcare industry
Claim errors will increase by 7%
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ICD-10 changes EVERYTHING
40% increase in A/R days (CMS)
200% rise in claim denial rates (CMS)
Justify the medical treatment
Complex denial appeals
....
Revenue and cash�ow impact of ICD-10
Source: Centers for Medicare and Medicaid Services
Scenario 1Vendor Readiness
What should you ask your current vendor?
What is your time frame for implementation?
What tools, training, and support will you provide to me and my sta� so we can prepare our practice for ICD-10?
Will your products be ready for the ICD-10 compliance date?
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?
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 ?
Will you help me test my ICD-10 compliant EHR and practice management system with my payers?
ICD-10 Readiness
Cost
Implementation
If your EHR Vendor does not respond in a timely manner or
if the responses you receive are vague
Consider Switching
Scenario 2Practice Readiness
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)
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Are you up for the challenge?
It is estimated that physician productivity will decrease by
10%-20% due to ICD-10 documentation
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ICD-10 will in�ltrate your domain
Source: American Academy of Professional Coders
Physicians
Nurses
Lab
Billing Coding
FrontDesk
ManagersClinical Area
Is your Billing department up for the challenge?
Where do your denials stand?
Denials > 4% = poor performance
Cost per denial = $30
Benchmarking important KPIs
...Administrative time
Patient care
1.
16 hours on ICD-10-CM
24 hours on ICD-10-PCS
10 hours on practice implementations
(AHIMA)
Started training coders?2.
Source: American Health Information Management Association
Hiring in-house billers? Professional coder costs $50,000. 3.
A/R management? Exceed 120 days
Periodic reports
Specialty-level comparison
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4.
Resources for PQRS and MU Stage 2?
5.
Is your practice on track ?
2015 2014 Oct Nov Dec
Ongoing practice before “go live” Ongoing practice before “go live”
DEADLINE
OCT
1
2015
PLANNING Identify resources Create project team Assess effects Create project plan Secure budget
COMMUNICATIONSInform staff Contact vendors Contact payersMonitor vendor prep Monitor payer prep
TESTINGHigh-level training for test team Level 1: internal Level 2: external
COMPREHENSIVE TRAININGDocumentation Coding
O c t N o v D e c J a n F e b M a r A p r M a y J u n J u l A u g S e p
If your practice is notprepared for ICD-10
Consider Outsourcing!
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.
Fact
Source: Black Book Rankings Survey 2014
In-house vs outsourced
In-h
ou
sePros Cons
Ou
tso
urc
edRetain Control
Less Expensive
Close Proximity
Transparent
Enhanced Consistency
Liabilities
Hands off
Staff issues
Hidden Fees
Higher costs
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.
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Choose the right billing vendor
Do not select a billing company solely on low rates without considering the risk attached to it
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
CureMDValue Proposition
ICD-10 ready softwareWe updated our cloud-based EHR in 2014, giving our providers ample of time to practice new codes beforethe deadline.
Our in-house experts will assist youthroughout the conversion process, helping you with training and successful implementation of ICD-10.
ICD-10 consultationteam
Still anxious about your prospects for successful ICD-10 conversion? We havea perfect solution for you. Give us yourmedical billing and concentrate on yourpatients.
Billing Service
Session
QA&
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
Need Help?
Thank you
Look out for our email, containing the webinarrecording and free ICD-10 ebook
