Medical billers are the workers in the healthcare industry who ensure that practices get paid. They take providers' services and translate them into billing claims, then ensure the claim leads to reimbursement. A good biller can improve a practice's revenue cycle management - but his or her duties extend beyond claims, especially with the ICD-10 transition on the horizon.
Typically, billers take care of charge entry, claims transmission, payment posting and follow-ups with payers and patients, while remaining in constant contact with physicians about diagnosis information. Like coders, billers need familiarity with the newest revision of the ICD codes. Since ICD-10 is slated to become the mandatory coding language for healthcare on Oct. 1, 2015, billers have a lot of work ahead of them. Along with learning the new code set, one of their primary jobs will be coordinating with software vendors to ensure their systems are up-to-date and ready not just for ICD-10, but also preliminary testing.
Prior to the transition, billers should work with physicians to hash out what their practices need from vendors. These essential questions provide an excellent guideline for the conversation that practices and vendors should have.
What are the testing timelines for both ICD-10 and the new 1500 forms? What are the implementation dates?
The official timeline from the Centers for Medicare and Medicaid Services (CMS) suggests that external testing between providers and payers should have started by the end of October 2013. For external testing to work effectively, however, vendors need to ensure their software is ICD-10 compliant. Many practices are behind the CMS timeline, but there's still ample time to run external testing - which is why providers need hard set dates from vendors.
CMS-1500 forms are claim forms for billing Medicare Fee-For-Service Contractors. Just recently, CMS updated the form to be compliant with ICD-10. Significant changes include a request to identify whether billers are using ICD-9 or ICD-10 codes and the choice to use as many as 12 codes in the diagnosis field - eight more than the previous paper 1500 forms allowed.
CMS has yet to announce a start date for the new 1500 implementation, but according to the agency, Medicare will tentatively begin receiving claims on the new 1500 form in January. By April, the agency plans to be exclusively accepting claims submitted on the new form.
However, practices submitting electronically will also need to touch base with their vendors to ensure that their medical billing software is updated for the revised form.
How is the vendor intending to address crossover coding from ICD-9 to ICD-10?
Dual coding is a strategy that many providers will be relying on to avoid significant accuracy loss as coders and billers begin filing claims using the new code set. Utilizing this approach will ensure that codes accurately go through and are processed correctly by payers. Plus, it has the added benefit of being a learning experience for providers.
But not all software vendors are releasing products that allow dual coding. Providers who want this feature should let their vendors know. Will ICD-10 compliant software only accept ICD-10 codes - or will the crossover be more gradual? Will there be features allowing for CMS' General Equivalency Mapping (GEM) files?
Will vendors be ready to accept codes on Oct. 1, 2015?
It's paramount that vendors are able to accept codes in order to process claims, so providers should ensure not only that in-house systems are updated for ICD-10, but that the vendors themselves will be prepared to receive codes in time for implementation. Of course, vendors are just one ring in the chain of stakeholders involved in billing. From payers to clearinghouses, providers need to check that each partner is prepared to work with one another.
How is the vendor testing with the major payers?
As payers gear up for implementation, they'll be coordinating with vendors to test software, note implementation issues and risks, and strategize for troubleshooting. Providers should make certain their vendors are working closely with payers to confirm their systems are up to par and ready to be used for claims. A payer-vouched vendor is a good sign.
Are vendor products ready for end-to-end testing?
End-to-end testing is the ultimate ICD-10 readiness test for payers, providers and vendors, requiring external testing to run from EHR software to practice management systems to clearinghouses to payers and then back again.
CMS has provided a series of extensive checklists for stakeholders of all sizes outlining the criteria and goals of this significant step. Before providers attempt it, they need to check with their vendors to ensure absolute preparation.