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ICD-10 Transition - Role of Clearing Houses and The Need Of Medical Billers And Coders!

The upcoming ICD-10 brings innumerable changes to care providers working environment not only in terms of changed or updated codes but also clinical and operational processes.

Hence physicians along with the coding changes will also to need to adapt to these process changes. Besides being educated about these changes the major challenge physicians’ face is being able to align themselves appropriately with resources that handle these processes. This concern brings us to realize that practices are looking for resources and organizations like clearing houses which can help them ensure smooth transition to ICD-10 and the medical billers and coders’ integral role in this process.

How can physicians benefit with clearing houses?

Earlier clearing houses have provided support to various physicians by altering claims from Version 4010 to Version 5010 format, during the change to Version 5010. In a similar way in context to ICD-10 clearinghouses can help by – ascertaining problems which can lead denial of claims. Also help by providing guidance on how to correct a denied claim with information like different or additional data required to be included.

Role of medical coders in helping physicians…

Though being able to provide some help with ICD-10; clearing houses will be unable to provide the same amount of assistance as they had with the Version 5010 upgrade. This limitation is essentially because ICD-10 represents a medical diagnosis or hospital inpatient procedure, and is based on clinical documentation.

Hence physicians short of time would essentially turn towards medical coders to update their knowledge in clinical documentation and coding to ensure smooth transition and accuracy. This would ensure better interaction with clearing houses as well and eventually help in quicker claim processing.

As clearinghousesface certain limitations mentioned above while helping physicians in the ICD-10 transition; medical billers and coders will play an essential role in both bridging this gap between providers and clearing houses along with guiding physicians with their specialized coding knowledge on -

  • Recognizing which ICD-10 codes need to be utilized
  • As one ICD-9 code may have manymatching ICD-10 codes, help providers understand ICD-10 codes high level of detailing
  • Updated with the right medical knowledge and familiarity with the specific clinical event; medical coders can help providers select the most suitable ICD-10 code

Very few clearinghouses may provide third-party billing/coding services, and those that would they too would find it difficult to translate ICD-9 to ICD-10 codes without the - detailed clinical documentation necessary to be acquired by a medical coder to be able to choose the right ICD-10 code.

Hence the assistance of certified medical billers and coders here is critical - as providers prepare for the October 1, 2014, ICD-10 deadline, with clearinghouses for testing ICD-10 claims processing and for pinpointingbeforehand any problems which need to be fixed in advance.

In this scenario as providers work with different resources and organizations, and attempt to bring together people and processes to help attain the most out of ICD-10, Medicalbillersandcoders.com - the largest consortium of medical billers and coders across all 50 US States is constantly updating their coders knowledge with ICD-10 transition techniques. We also help coders get access to the numerous upcoming ICD-10 and other opportunities through our job portal.

Additionally MBC’s ability to give insightful advice on ICD-10, helps provide ICD-training program; which comprises of webinars, forums, and online learning material, and latest updates.

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