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presentation

Understanding the ICD-10 impact on DME Billing

July 28, 2015



Understanding the ICD-10 impact on DME Billing

The International Classification of Diseases – 10th revision is set to be active from October 2015. All the practices are gearing up to meet that deadline. They want to make sure that their billing is done properly as per the extant rules. It is imperative that DME’s continue to improve documentation which will help them in supporting quality, severity, and risk which is involved with patient care, resulting in higher levels of evaluation and management services and more revenue.

The ICD–10 codes are used to classify diagnoses and procedures on claims which are submitted to Medicare and private insurance payers. The 10th revision will help in detailing patient history and helping in coordinating patient’s care across providers over a period of time. Furthermore, it will help in detecting and preventing fraud and abuse leading to accuracy of reimbursement.

As far as providers are concerned they will be able to capture more data which will help them in treating patients better as compared to ICD – 9. Furthermore, it will also help researchers and public health officials to track diseases as ICD – 10 will give more data to them. This new revision reflects on improved diagnosis of chronic illnesses and identifies the underlying causes and throws light on conditions that contribute to the complexity of a disease. Additionally, it also captures the severity and the stage at which the disease is currently at, such as chronic kidney disease, diabetes and asthma.

Are DME’s ready for ICD – 10

If for any reason DME’s cannot make the necessary system changes to submit the claims with ICD – 10 codes by 1st October, 2015 or they are unable to submit claims due to issues with the billing software, billing vendor or clearing house then they can avail the free billing software provided by CEDI which is PC – ACE Pro 32 which has been updated to support ICD – 10.

The software download is free but there might be fees attached to submit claims through a network service vendor. One should note that this billing software only works for submitting fee for service claims to Medicare. The idea is to provide DME’s with an ICD – 10 complaint claims submission format; it does not provide coding assistance.

Few steps to ensure smooth transition

  1. Durable Medical Equipment Billing teams can map out the 10 top ICD – 9 codes which are billed regularly and map out the ICD – 10 codes accordingly. In case there is additional information that needs to be provided, it must be gathered right away
  2. Documentation of patients presently undergoing treatment needs to be taken care of properly. As of October 1, 2015 they should be coded as per the new ICD codes
  3. DME’s should talk to their software vendors to ensure that they are taking the necessary actions to meet the new requirements set by ICD – 10

It would augur well for DME’s to take assistance from medical billing companies who can help them streamline their entire ICD 10 implementation ensuring no revenue loss. These billing companies assure a seamless ICD-9 to ICD-10 transition & help you stay on track as per the standard requirements set by CMS.

 

Category : Best Billing and Coding Practices