Given the increasing complexities of reforms that are affecting the day-to-day operations of healthcare organizations, a generalized workforce has to make way for specialists responsible for specific areas with clearly defined tasks to perform.
In a healthcare operation driven by specialists, a physician will know who to handover medical details to, to be used for billing and coding; there will be a person or a team (as the need may be depending on volumes) to assess the insurance coverage available for a patient; someone to pick and choose the correct codes for the services rendered, etc.
In other words, there should be specialists to handle all the medical and non-medical activities involved from the time a patient walks in through the time the patient is discharged to post surgery activities if part of a treatment episode.
The following points will bear out why exactly healthcare reforms have made a specialized workforce for billing and coding unavoidable.
One of the major areas of reforms is ICD 10. What makes adapting to this reform in billing standard challenging is that it’s vastly different from its predecessor, ICD 9. A significant point of difference is the structure and number of ICD 10 codes.
- ICD 9 codes were numeric five-character long whereas ICD 10 codes are alphanumeric seven character long
- There were around 18000 ICD 9 codes, while there are 140000 ICD codes
This structure and numerical strength enables ICD 10 codes to cover conditions and sub-conditions which went unattended by ICD 9.
And, as is obvious, handling ICD 10 codes, given their complexities, is not a job of a generalist – but an expert with experience in coding and training in handling ICD 10 codes. Additionally, ICD 10 codes require much more documentation to support codes used. This documentation is of medical nature for which there should be a specialist with the knowledge of codes and medical details to interface between your billers and codes and physicians helping one to understand the needs of the other and meet them.
Similarly, Affordable Care Act (ACA) has increased the number of insured patients in America, but not every American enjoys equal amount of coverage nor are their insurances governed by the same rules. This makes insurance verification an area which not just requires attention but by a person (or team) who is solely dedicated to it and not a receptionist who does it when not attending to visitors.
These are just a few examples of how reforms are making specialization in billing and coding areas (and others) unavoidable. Alas, over-specialization also increases cost overheads and diverts a chuck of operational cost to non-medical areas.
If you have an in-house billing and coding cell, MBC’s Revenue Management Consulting services can help you by assessing your revenue management cycle and help you identify areas for training, so that you can be more equipped to handle the complexities brought in by reforms and changing dynamics of the healthcare industry.
Additionally, we can help ensure that there is sound coordination between various components of operations facilitating smooth flow of medical data, a need for handling ICD 10 codes. We also help identify gaps in your process and address them by replacing, if necessary, old software applications with new ones and blocking areas of revenue leakage.
Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, has also been helping several small to medium size practices with its Outsourcing medical billing services handling the entire range of activities involved in billing and coding starting from preparation of claims through submission to post-submission follow-ups. Our service modules are flexible and, instead of opting for complete service packages, you can pick and choose such parts of our services as exactly fit your billing coding needs. Thus you can save time you are now spending on billing and coding and focus all your resources solely on healthcare.