medical billing managerSince your practice’s medical billing department controls both revenue volume and cash flow, its performance bar is already pretty high. In less than a year, that bar will have to raise several notches.
Two events conspire to make 2015 a trying year for medical practices and their billing departments: Meaningful Use and the ICD-10 deadline. And given the last two year’s delay of ICD-10, it will unlikely be moved again a third time. So next year, practices will be facing noncompliance penalties for Meaningful Use Stage 1 even as some organizations prepare to meet Meaningful Use Stage 2––all while in the throes of the most significant transition to hit the medical industry since HIPAA.
Although the main burden of the ICD-10 changeover will fall on physicians themselves, their billing departments will struggle with their irrevocable responsibility of payer adjudication, which means it will no longer be enough to have an experienced billing staff. Unless the physician has already mastered ICD-10, continual contact to determine highest diagnosis specificity will be required, placing a drain the physician’s time to see patients.
Payer delays coinciding with dips in physician productivity will strain revenue. Re-billing denials will further add to that strain. In order to spread out a staff’s demand on physician’s time, billing departments will soon (read immediately) need to submit to the dual-coding mandate prescribed by seasoned billing consultants and ‘best-practice’ advocates––a minimum requirement of 3 months of dual coding (coding in both ICD-9 and ICD-10) and which covers 80% of a practice’s main source of revenue.
The main hurdle to dual coding are time constraints and allocation of human resource. So as a medical practice, do I simply place an ad to hire an additional coder? Smart organizations when facing difficult times have learned to hire experienced managers and place them in the breach.
The bottom line is that medical practices who want to protect their cashflow through the turbulent waters of 2015 will require both an ICD-10 proficient billing manager and the sophisticated Revenue Cycle Management software they’ll require to maintain control of day to day efficiency and revenue.
To be specific, your practice needs a medical billing manager that:

  • Has at least five years medical billing experience
  • Is trained on ICD-9, ICD-10, and CPT codes
  • Possesses an exhaustive understanding of the revenue cycle
  • Understands the claims process from end to end
  • Can resolve claim processing issues on a timely basis by reviewing claim inventories and taking appropriate action
  • Is familiar with all appropriate billing forms (state and federal)
  • Has an excellent understanding of process management
  • Has top-notch project management and organizational skills
  • Thoroughly understands billing best practices and standard procedures
  • Can perform analytical reviews and quality assurance to ensure data integrity
  • Can work closely with management to ensure efficient processes are understood and implemented
  • Is able to proactively establish new billing policies and procedures
  • Can identify reasons for billing delays and mitigate those issues
  • Can identify and communicate charging or edit trends and provide examples to other departments to reduce errors

Furthermore, your billing manager needs software that:

  • Provides dual coding in ICD-9 and ICD-10
  • Provides inter-office communication, task assignment, and work queue’s
  • Is subscription based and includes upgrades, so your system always includes the latest technology and features
  • Meets the majority of HIPAA compliance rules for data security
  • Fully integrates with your front-office systems (eligibility), your EHR, and your medical practice software
  • Supports automated denial management, recovery management, and collections
  • Gives billers full, instant access to clinical notes so they can code to the highest level of specificity
  • Provides status reports on key financial data, including AR levels, claims denial rates, eligibility issues

Given that experience billing managers are already a precious commodity, and given that the most talented ones (e.g. ones proficient in ICD-10 coding) are undoubtedly in the most pivotal jobs commanding the highest salaries, for many practices attracting the required talent may be an unobtainable ideal unless they’ve spent the last two years training their in-house office staff and are well on their way to completing the dual coding initiative.
HARDEST TO BE HIT
If you are a cardiologist, radiologist, or an ophthalmologist, some existing ICD-9 codes will expand to 2500 to 1 code choices. Seeing that 2015 is already upon us, in addition to dual coding software, a smooth transition to ICD-10 will require immediate attention including a gap analysis, an action plan, and continual monitoring with checks and balances to keep physicians on track. But needless to say, it’s time for everyone to take a close look at our medical billing departments and see just how high the bar will need to go—and who’s going to lift it.
Physician Billing Services Case Study

Last Updated on October 9, 2014