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ICD-10 Medical Billing by MDeverywhere

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With the upcoming coding changes there are estimates that practices will spend 3% of their annual revenues on this transition. The assumptions are that these costs will be put towards staff training, …

With the upcoming coding changes there are estimates that practices will spend 3% of their annual revenues on this transition. The assumptions are that these costs will be put towards staff training, upgrading software, and changing business and clinical workflows. With MDeverywhere’s cloud based solution we consider it our job to ensure the system is compliant with the changes, and we will not charge our clients any extra fees to complete this work.

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  • 1. ICD-10 Is Coming….. Will You Be Ready?
  • 2. ICD-10 Reality ICD-10 is the biggest change to face our industry in decades - ICD-9 schema has been in place for 30 years! Basically everything changes.....and the disruption is real. • We will update our systems at no cost to you. • Every PM system in use today is going to require, at minimum, an upgrade and maybe a full conversion. • Billing & Coding staff will require many hours of training and recertification. • We are releasing a “Sandbox” for clients to practice with the new codes and be fully prepared for this change.
  • 3. ICD-10: The Reality • Most practices simply do not have the systems, the capital, or the training to operate effectively in the world of ICD-10. • MDeverywhere ICD-10 Guarantee: •Our systems will be fully ICD-10 Compliant by January 1, 2014. Guaranteed. CMS Warning: • Chance for disruption in cash flow is high. • Recommends having 6 months of cash on hand.
  • 4. Estimated Costs Business Aspect Typical Small Practice Typical Medium Practice Typical Large Practice Education $2,405 $4,745 $46,280 Process Analysis $6,900 $12,000 $48,000 Changes to Superbills $2,985 $9,950 $99,500 IT Costs $7,500 $15,000 $100,000 Increased Documentation Costs $44,000 $178,500 $1,785,000 Cash Flow Disruption $19,500 $65,000 $650,000 TOTAL $83,290 $285,195 $2,728,780
  • 5. Why The Change? •ICD-10 provides more specific data than ICD-9 •Better reflects current medical practice •Structure accommodates addition of new codes •Expanded data capture •Quality measurement •Reduce coding errors •Efficient claim submissions •Identify fraud and abuse •Track and respond to public health outbreaks •Enhanced analysis of disease patterns
  • 6. Why Is It Such A Big Deal? •ICD-10 provides more specific data than ICD-9 •Major change in the coding system •14,400 ICD-9 diagnosis codes to 69,368+ ICD-10 diagnosis codes •3,800 ICD-9 procedure codes to 72,000 ICD-10 procedure codes •Major changes in structure of the codes •Major changes in coding rules •Major changes in terminology
  • 7. Code Freeze Timeline Effective October 1, 2015: Make the switch to ICD-10. All services and discharges on or after October 1, 2015 must be coded using the ICD-10 code set. Transactions that continue to use the ICD-9 codes will be rejected. ICD-10 codes cannot be used prior to the October 1, 2015 compliance date.
  • 8. Billing And Coding Issues To Consider •New code sets •Dual Systems •Claim Follow through and Resubmissions •Productivity Issues •Policies and Procedures •Contracting Changes •Denial Management
  • 9. ICD-10 requires a hybrid approach. Traditional solutions won’t cut it. Outsourced Billing MDeverywhere – Insourcing Full Control • Cash • Real-time access to data • Full visibility – 24/7 Fully Mobile & Accessible • iOS • Android • Window Access to line item detail by account Team approach to claims processing, correspondence management and denial handling. Lack of visibility Lack of control No Accountability Your Options Inhouse Billing System Upgrades/Conversions • Disruption • Cost Fixed Costs • System – license, support & maintenance • Hardware • Staff • Claim Submission • Office Space • Training Risk of Instability • Staff Turnover • Hiring the right expertise Traditional Solutions Today’s Hybrid Approach VS VS
  • 10. Contact Us Phone # (631) 232-4260 Option 4 Email: sales@mdeverywhere.com or questions@mdeverywhere.com THANK YOU

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