Medical Billing Coding, ICD-10

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ICD-10 Implementation, New Features, Benefits,
and Our Plan of Action for Internal Medicine
Web www.vocisinc.com Sales 866 365 3909 Email
contact_at_vocisinc.com
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ICD-10-CM/PCS COMPLIANCE DATE

• Implementation scheduled for 1st October 2014
• Testing of these codes starts effective January
  2014

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BENEFITS OF ICD-10-CM

• ICD-10-CM incorporates much greater clinical
  detail and will be more specific than ICD-9-CM.
• For example ICD-10 for Right knee pain-M25.561
  and Left knee pain-M25.562 where as ICD-9 for
  Right or Left knee pain 719.46
• Reducing the need for attachments to explain the
  patients condition
• Improving clinical, financial, and administrative
  performance
• Preventing health care fraud and will be more
  informative
• Once coding is completed , ICD-10 makes claim
  submission more efficient

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Difference
ICD-9 ICD-10
Consists of 3 5 characters Eg. Rotator cuff sprain and strain is 840.4 Consists of 3 7 characters Eg. Rotator cuff sprain and strain is S43.429A
1st character is alpha or numeric Eg. Hip Pain 719.45 1st character is always alpha Eg. Hip Pain M25.559
Shorter code description as not specific and abbreviated codes Eg. Rotator cuff sprain and strain is 840.4 Longer code description as more specific and detailed codes Eg. Rotator cuff sprain and strain is S43.429A
13,600 codes 69,000 codes
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DIAGNOSIS ICD 9 ICD 10 ICD 10
Hypertension Hypertension Hypertension Hypertension
Hypertension, unspecified 401.9 401.9 I10
Hypertension, uncontrolled 401 401 I10

Diabetes Diabetes Diabetes Diabetes
DM type 2 250 250 E11.9
DM type ii, Uncontrolled 250.02 250.02 E11.65
DM type 1 250.01 250.01 E10.9
DM type 1, uncontrolled 250.03 250.03 E10.65

Neoplasm Neoplasm Neoplasm Neoplasm
Malignant neoplasm, lung 162.9 162.9 C34.90
Metastatic neoplasm liver 197 197 C78.00
Benign neoplasm, lung 212.3 212.3 D14.30
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Frequently Used Codes VOCIS observation

• VOCIS checked the documentation for the most
  often used codes in your practice

Diagnosis ICD 9 ICD 10
Hypertension 401.9 I10
Chronic pain syndrome 338.4 G89.4
Congestive heart failure 428.0 I50.9
Long term medication V58.69 Z79.899
Fatigue 780.79 R53.1
Constipation 564.00 K59.00
Allergic rhinitis 477.9 J30.9
Back pain 724.5 M54.9
Continued
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Diagnosis ICD 9 ICD 10
Diabetes - Type II 250.00 E11.9
Hyperlipidemia 272.4 E78.5
Degenerative Disc Disease Lumbar Spine 722.52 M51.36
Anxiety 300.00 F41.9
Depression 311 F32.9
Chronic pain 338.29 G89.29
Anemia 285.9 D64.9
Atrial Fibrillation 427.31 I48.91
Coronary Artery Disease 414.00 I25.10
Cerebral Vascular Accident 434.91 I63.50
Degenerative Disc Disease Cervical Spine 722.4 M50.30
Hypothyroidism 244.9 E03.9
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ICD-10 impact on Revenue Cycle Management
VOCIS anticipation

• Delayed reimbursement from government during
  ICD-10 implementation as this is in the
  transition phase, some delays can be expected
• Account Receivable days may increase by 20 to 40
  percent post implementation through a transition
  period
• As per survey Workgroup for Electronic Data
  Interchange (WEDI) (the leading authority on
  the use of Health IT to improve healthcare
  information exchange in order to enhance the
  quality of care, improve efficiency and to reduce
  costs of the American healthcare system)
  estimates that rejection and denial rates may
  increase by 100 200 percent during the same
  period

Continued
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VOCIS Plan of Action

• We have already started training for our staff on
  ICD-10 implementation via attending Webinars and
  trainings arranged by AAPC
• Will keep educating the Providers on the updates
  and changes for ICD-10 implementation
• ICD-10 codes is already imported in the billing
  software so that the testing can be started at
  the earliest and to get familiar with new codes
  Testing starts effective Jan 2014
• Generally we accept 45-60 days in AR as quite
  reasonable, but we would have to be more
  aggressive , more goal oriented. In actual words
  its time to challenge the process
• VOCIS planned to focus on the AR a bit early so
  that the denials can be captured on time and can
  be worked accordingly. This will fasten the
  payment process.

Continued
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• Few of the AR reporting will help to manage the
  accounts
• Zero to 30 days, separated by payer
• Daily and weekly revenue
• Outstanding days
• Insurance verification for all the
  patients/accounts will be checked before billing
  the claim to insurance. This will ensure that we
  are billing the claim to the right insurance and
  will speed up the payment process and at the same
  time will reduce the denials

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Additional Information

• New claim form/CMS-1500 named 02/12 form (sample
  on next page)will be used, with more columns to
  add the ICD-10 codes which results in more
  accurate payment flow from the insurance side
• The current claim form/CMS-1500 has the
  limitation of using only 4 ICD-9 codes
• During the training period we will bill ICD-9
  and ICD-10 simultaneously to the insurance on the
  same claim form to ensure that we are billing
  correct codes
• The version 02/12 form will likely be accepted by
  Medicare in January of 2014, but providers can
  still use the old forms until April 1, 2014, when
  only the 02/12 form will be accepted

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Suggestions - Important for Providers

• Providers will need to improve documentation
  because unless they are as specific as possible,
  coding staff will never be able to assign the
  right code which might lead to billing
  complications
• Front desk should always discuss the patient
  responsibility before treatment and COPAY should
  be collected on the day of service also patient
  should be informed of the left over balance after
  the insurance pays will be Patients
  responsibility
• ICD-10 implementation may require the need for
  financial back up OR line of credit to offset
  cash flow challenges due to government glitches

Continued
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NEW FEATURES IN ICD-10-CM

• Laterality (Left, Right, Bilateral)
• Examples
• C50.511 Malignant neoplasm of lower-outer
  quadrant of right female breast
• H16.013 Central corneal ulcer, bilateral and
• L89.012 Pressure ulcer of right elbow, stage
  II.
• Combination Codes For Certain Conditions and
  Common Associated Symptoms and Manifestations
• Examples
• K57.21 Diverticulitis of large intestine with
  perforation and abscess with bleeding
• E11.341 Type 2 diabetes mellitus with severe
  nonproliferative diabetic retinopathy with
  macular edema and

Continued
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• Character x is Used as a 5th Character
  Placeholder in Certain 6 Character Codes to Allow
  for Future Expansion and to Fill in Other Empty
  Characters (For Example, Character 5 and/or 6)
  When a Code That is Less Than 6 Characters in
  Length Requires a 7th Character
• Examples
• T46.1x5A Adverse effect of calcium-channel
  blockers, initial encounter and
• T15.02xD Foreign body in cornea, left eye,
  subsequent encounter
• Inclusion of Clinical Concepts That Do Not Exist
  in ICD-9-CM (For Example, Underdosing, Blood
  Type, Blood Alcohol Level)
• Examples
• T45.526D Underdosing of antithrombotic drugs,
  subsequent encounter
• Z67.40 Type O blood, Rh positive and
• Y90.6 Blood alcohol level of 120 199 mg/100
  ml.

Continued
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• A Number of Codes Are Significantly Expanded (For
  Example, Injuries, Diabetes, Substance Abuse,
  Postoperative Complications)
• Examples
• E10.610 Type 1 diabetes mellitus with diabetic
  neuropathic arthropathy
• F10.182 Alcohol abuse with alcohol-induced
  sleep disorder and
• T82.02xA Displacement of heart valve
  prosthesis, initial encounter

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Who We Are

• In 2000, A group of Healthcare Industry veteran
  talents teamed up to launch, 'Vocis', an
  organization with a difference, that specialized
  in making medical groups more competitive for
  today's world
• Advised and owned by Physicians
• A BBB Accredited Practice Management Company
  based in Louisville KY, involved in Medical
  Credentialing, Billing, Collections,
  Transcription, Practice Marketing, Virtual
  Receptionist, and Practice Set up for independent
  NPs, PTs, and MDs
• Successfully providing services to over 150
  satisfied customers all over US
• Experienced team of AAPC Certified Coders,
  Billing Specialists, AR Analysts, Denial
  Management Specialists, Quality Analysts and
  backed by experienced team of Software, Network
  and Hardware Engineers
• State-Of-Art IT infrastructure center comprises
  of HP PCs, High speed internet leased line with
  assured 24/7 connectivity, Network Server
  monitoring, Data Back-up Remote storage
  facility and 100 power back-up

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We Offer

• Fee Schedule Review and Analysis
• Eligibility and Benefit Verification
• Assistance with Provider Enrollment
• Electronic and Paper Claims Submission
• Account Receivables
• Secondary Insurance Billing
• Inbound/Outbound calling
• Workers Comp and No Fault

• Patient Demographics Entry
• Authorization Request and Tracking
• Charge Entry All Specialties
• Posting of Insurance and Patient Payments
• Patient Statement
• Denial Review and Management
• Customized management reports
• Medical Coding

Web www.vocisinc.com Sales 866 365 3909 Email
contact_at_vocisinc.com
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Pricing
The pricing structure for VOCISs billing and
coding services is straightforward, and
calculated as a percentage of your organizations
monthly net collections. To the contrary, the
pricing is determined by a detailed analysis of
your organizations key characteristics, finances
and other data. We charge just 4 to 8 of
collected amount
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Contact Us

• Sales
• 866 365 3909
• General Information
• Phone [phone]
• Web vocisinc.com
• Email contact_at_vocisinc.com