As we stand at the mid of the intervening period, there is growing apprehension over achieving comprehensive realization of ICD-10 and other Compliance standard implementation by the October 1, 2013 deadline across the spectrum of healthcare stake-holding: health care providers, payers, software vendors, and clearinghouses/third-party billers.

The CMS has drawn up detailed timelines for phased implementation:

  • payers and providers to begin internal testing of version 5010 standards for electronic claims by January 1, 2010
  • Internal testing of version 5010 to be completed to achieve Level I of version 5010 compliance by December 31, 2010
  • By January 1, 2011, payers and providers to begin external testing of version 5010 for electronic claims as CMS begins accepting Version 5010 claims while Version 4010 claims continue to be accepted
  • External testing of Version 5010 for electronic claims to be complete to achieve Level II of version 5010 compliance by December 31, 2011
  • By January 1, 2012, all electronic claims to use version 5010 as version 4010 claims will no longer be accepted
  • Beginning with October 1, 2013, claims for services provided on or after this date to use ICD-10 codes for medical diagnosis and inpatient procedures Whereas CPT codes will continue to be used for only outpatient services

Despite the specified deadlines, the medical fraternity, already rattled by imminent impact of Debt ceiling and SGR reforms on Medicare payments, may not be as responsive as it would have been normally.

HIPAA 5010 – which requires over 800 changes from the 9 transactions in the previous 4010 – is seen as enabler of comprehensive classification and coverage of transactions for privacy compliant reporting, and a platform for adopting ICD-10 codes, and ICD-10 – which accommodates over 68,000 ICD-10-CM codes, and 87,000 ICD-10-PCS codes – proves to be pervasive coding system eliminating ambiguity surrounding the preceding ICD-9.

Despite their respective merits, physicians/hospitals – who are already grappling with operational costs associated with medical billing services – will find it even more cumbersome to adopt them owing to

  • Heavy Cost Associated with Migration
  • Complex Technology Implementation
  • Training and Orienting Staff to New System, and
  • Establishing Logistical Relationship with Medical Billers and Insurance Carriers

Federal Government subsidies or incentive too cannot be counted on as the Federal Government itself is preoccupied with solving monstrous economic problems. But, having to abide by Federal dictum, physicians/hospitals will be left with no avail but to practice the system as mandated, absence of which will render their medical billing ineffective.

In such a scenario, proactive medical billing companies that have the requisite competence in place to enable their trusting clients to migrate smoothly and efficiently to the ensuing ICD-10 system of medical coding, and HIPAA 5010 compliant reporting are of crucial help. Moreover, hiring expert support will go a long way in realistically realizing the anticipated return on the investment incurred during the transition.

Specifically geared up for the occasion, – having delivered efficient medical billing management for a majority of physicians/hospitals/clinics across the United States – has the wherewithal to successfully manage the demands of the ICD-10 system of medical coding, and HIPAA 5010 compliant reporting.

Riding on an paralleled set of pre-qualifiers – certified by the American Association of Professional Coders (AAPC); proficient in using advanced medical billing and coding software as required by the ICD-10 system of medical coding, and HIPAA 5010 compliant reporting; and an impressive track-record of maximum and efficient reimbursement of medical bills with the leading private insurance carriers such as United health, Wellpoint, Aetna, Humana, HCSC, Blue Cross Group, and Government sponsored Medicare and Medicaid as well – our medical billing professionals carry an imperial edge in the industry.

Our medical billing experts – who are adept at accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards – have been crucial to physicians/clinics/hospitals’ operational efficiency and revenue maximization.

Published By - Medical Billers and Coders
Published Date - Sep-06-2011 Back

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