Outsourcing Medical Billing Services and the ICD-10 Deadline

The final rule regarding the ICD-10 changes and the implementation of the deadline for October 1, 2015 was issued by the U.S. Department of Health and Human Services on July 31, 2014. In addition to transitioning to the ICD-10 deadline and code sets on October 1st, part of the ruling requires entities that are covered by HIPAA to continue using ICD-9-CM through September 30, 2015 in advance of the deadline date. As a result of these changes, many health care providers have upgraded their systems and sought outside help, such as medical consultation and even outsourcing medical billing services so they would be prepared and compliant by the deadline date.

What Is ICD-10 and What Are the Changes?

ICD stands for the International Statistical Classification of Diseases and Related Health Problems. The 10 in the ICD-10 deadline stands for the 10th revision of this classification in the United States by the National Center for Health Statistics (NCHS), which is a federal agency. The ICD-10 changes will be used for clinical coding optimization across all medical services nationwide and has already been used to code and classify mortality data from death certificates in the U.S. since January 1, 1999.

The World Health Organization (WHO) owns and publishes the ICD classification and has copyrighted the ICD-10. The development of an adaptation of the ICD-10 changes has been authorized by WHO for use throughout the United States for government purposes and, according to the agreement, any changes or modifications made must conform to the WHO conventions for the ICD. The modification of this that the United States government is implementing is known as ICD-10-CM. It was developed through evaluation and extensive consultations with clinical coders, physicians groups and other industry experts.

For details on the ICD-10 changes from ICD-9, physicians and clinical coders can view the entire draft online at the NCHS website. They were made available for public comment and input between December 1997 and February 1998. Field tests were run using ICD-10-CM in 2003 by the American Health Information Management Association and the American Hospital Association to ensure clinical coding optimization, accuracy and utility. All of the comments that were provided during the public comment period were reviewed and considered to make modifications based upon the suggestions. Since that time, new modifications have also been made based upon changes made to the ICD-9-CM between 2003 and 2011, as well changes made to the WHO ICD-10 between 2002 and 2010.

What Does This Mean to My Practice?

All of these modifications that have lead to the upcoming October 1, 2015 ICD-10 deadline for hospitals, clinics and medical practices within the United States are designed to be a significant improvement with regard to clinical coding optimization to help improve the information provided that is relevant to medical treatment and billing. Rather than completely re-train staff regarding the ICD-10 changes, which have already been delayed a number of times as modifications have been made, many clinics and practices have opted for outsourcing medical billing services to a trusted provider.

Through professional consultations with organizations such as MD Pro Solutions, other practices have been able to train and get credentials for their medical billing staff to improve account management and prepare for the ICD-10 deadline. Because the ICD-9-CM needs to continue to be used until the day before the ICD-10 changes take place, some clinics and practices have opted for outsourcing medical billing services up until that time while using the time up until the ICD-10 deadline to train and credential their staff to avoid any confusion about clinical coding optimization in-house.

Some of the ICD-10 changes include:

• expanded injury codes
• addition of sixth and seventh characters
• creation of combination diagnosis/symptom codes to reduce code volume
• addition of information relevant to managed care and ambulatory encounters
• incorporation of common fourth and fifth digit sub-classifications
• increased specificity in code assignment
• opportunities for expansion in the future as needed

The ICD-10 Deadline and Your ENT Practice

MD Pro Solutions specializes in providing medical consultation services to clinics, practices and physicians who serve patients within the field of Otolaryngology. We help find solutions for medical billing services, clinical coding optimization, administration and practice management through our specialized services. We have over 45 years of experience working within the medical billing and administration industry and have developed a series of solutions that are designed specifically for ENT practices and clinics. We will work directly with you and your staff to help you prepare for the ICD-10 changes, boost revenue and improve your medical billing practices. Some of our solutions include improved education, better tools, professional support and recommendations for outsourcing medical billing services, on a case by case basis.

At MD Pro Solutions, our clients are not required to change their medical billing services. Our goal is to provide you with top quality medical consultation services, not to change everything about your medical billing system. We will work with you and your current provider to ensure that your insurance claims are being processed accurately according to industry and insurance requirements. Through the help of our services, we have been able to increase revenue for most of our clients by at least ten percent in just the first year. For more information on our services or to find out how we can help you get through the ICD-10 changes ahead of the deadline, contact us at 508-946-1665.