Months ago we warned of the approaching end of the ICD-10 ‘grace period’ coming October 1—and how health care practices who hadn’t yet mastered the intricacies of ICD-10 faced the likelihood of increased claim denials from Medicare and private payors.
October 1 has of course come and gone, and the post-grace period dust is still settling. While most healthcare administrators have done their due diligence toward ICD-10 proficiency, we’re startled by the number of physicians we’ve talked to—radiologists in particular—who have yet to fully engage in this new coding standard. “I don’t do the coding—my billing staff handles that” is a response we hear far too often.
Profitability in the Age of Value-Based Care
As U.S. healthcare continues to transition from a fee-for-service model to value-based care—treatment centered on medical necessity—payors will increasingly structure their pay schedules around precise ICD-10 codes. This means a radiologist will need to be fully engaged and proficient in ICD-10 to justify the necessity every diagnostic procedure—such as a head scan of a lung cancer patient to rule out metastization to the brain following chronic headaches or dizziness. That radiologist can either precisely code that tricky diagnosis directly, or rely upon their staff for accurate “second hand” coding later. If they get it wrong—or too “generalized”—that insurance claim may be declared as exceeding medical need—resulting a medically valid procedure netting a significantly lower amount, if not a flat-out denial.
What Else Is Falling Through The Cracks?
Another disturbing trend we’ve observed with among radiology groups’ existing billing practices during the transition to ICD-10 is how billing specialists regularly struggle to manage their daily queues of outgoing claims. When billing teams are swamped with heavy workloads, they tend to generalize their coding. In their haste to get a claim out the door, they may categorize a simple leg fracture without including other related symptoms—such as joint pain, edema or effusion—which have their own subclassifications within ICD-10. Overlooking these additional symptoms means the unnecessary loss of important extra revenue.
Infinx to the Rescue
The final transition to ICD-10 doesn’t have to be a revenue-losing headache. Infinx developed our comprehensive ICD-10 Rescue solution for radiology groups and other medical practices to ensure accurate coding and assure every last incoming dollar:
- ICD-10 best practices training for physicians and their support staff—including coding and documentation management
- Real-time support from the Infinx team of 200+ AAPC certified medical coders
- Backlog reduction with audits to ensure 99% accuracy
- Advanced analytics to streamline in-house billing and A/R operations
How can our ICD-10 Rescue solution eliminate the coding and billing hassles for your practice? Contact us for more information today.