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How your Cardiology can Ensure Appropriate Reimbursements with ICD-10

November 06, 2015

How your Cardiology can Ensure Appropriate Reimbursements with ICD-10

By now it is a well known fact that failure to implement ICD-10 coding system can lead to a domino effect affecting medical coding and medical billing backlogs, causing a cash flow delay, which in turn can increase claim rejections and/or denials thus causing unintended shifts in payments affecting Revenue Management. Moreover inaccurate clinical coding further leads to misinterpreted information about patient care which can have disastrous consequences in terms of faulty investment decisions to improve health delivery. This attack, right at the heart of the matter can cause disruption in the smooth flow of the Revenue Management Services of cardiology services in particular.

When implementing ICD-10 into your Cardiology practice certain practices should be integrated in order to ensure appropriate reimbursements

  • Ensure that any product employed in your cardiology procedure is FDA approved, as some payers, including some Medicare contractors, may treat it as a non-covered service.
  • Documentation of Timeframes for an incident is very vital and should be documented as that is now taken into consideration when employing the ICD-10 coding system
  • The ICD-10 transition has brought in increased Terminology and Specificity of the incidence- hence medical coders/Coding services with updated knowledge and documentation with great accuracy is the need of the hour
  • Medical Coders or those involved in code mapping services need to be able to now translate the clinical information from the operative report into the ICD10 system with greater accuracy. One incorrect character can undermine your claim
  • With respect to outpatient billing, Medicare reimburses hospitals for outpatient stays of less than two midnights under the Ambulatory Payment Classification groups. However, comprehensive APCs is known to now reimburse a single all-inclusive payment for the primary service and hence no additional reimbursement for additional adjunctive services and supplies used during the delivery of the primary procedure is now permissible. Hospitals are thus encouraged to report device category codes (C-codes) on claims when such devices are used in conjunction with procedure(s) billed and paid for under the OPPS.
  • With respect to inpatient services, ensure that new Diagnostic Related Groups (DRG) methodologies are put into effect to help translate the new codes into DRGs for payment, given that reimbursement rates based on negotiated case rates tied to specific DRGs will be most impacted. Depending upon the Diagnostic Related Groupers reimbursement rates may vary with the shift to the ICD-10 coding system. For example, cases assigned to MS-DRG 003, ECMO or Tracheostomy with Mechanical Ventilation for 96+ Hours and billed according will show a small increase in reimbursements. Incorrect coding will lead to incorrectly assigned Diagnostic Related Grouper which could cause drop in reimbursements thus affecting the Revenue Management Services.

At the heart of the matter is accurate documentation, translation of the clinical matter into the relevant and appropriate ICD-10 codes and an understanding of Diagnostic related Groupers, especially with respect to inpatient services, a combination which can help improve revenues, which can best be outsourced to Medical Coding & Billing Services, while cardiologists best focus on the health delivery of the patient and use the resources for better implementation of healthcare


Category : Revenue Cycle Management