Outsource2india Assisted a Florida-based Medical Billing Company with ICD-10 Implementation

Case Study on ICD-10 Implementation for Medical Billing Firm

The Client

The client is a mid-sized medical billing company established in 2005 and based out of Florida with billing proficiency in over 40 specialties. They were providing billing services to over 20 hospitals around the US and had processed monthly claims that were valued over $900,000.

The Client Requirement

The client lacked medical coding expertise despite having sound process knowledge surrounding billing, revenue cycle management, and payment collection. When struct by new changes in ICD-10, their productivity was affected. Our client was opposed to letting the challenge resolve on its own as productivity was already lost beyond the acceptable threshold since the new wave of modifications to ICD-10. At this juncture, Outsource2india was contacted with the following requirements -

Simplifying the ICD-10 codes after the ingress of fresh changes
Advising their in-house coding team in complex procedures on heart and spine
Accurately interpreting the latest coding guidelines

Project Challenges

The biggest challenge ahead of us was to ensure clients' readiness to carry out billing as per the updated changes within a stipulated time. Since we were in the process of soaking up the modified changes in the ICD-10, training the client's team was an arduous task. One other obstacle was inspiring the team at client's end to positively embrace the training process and ensure utmost dedication towards understanding and enforcing the new change. Also, we were tasked to shrink the learning curve to meet the deadlines on time.

Our Solution

O2I's team was proficient in facilitating the transition from ICD-9 to ICD-10 because we have been rehearsing the process of transition from late 2011. In time, when we received the first opportunity to carry out the transition, we were fully prepared in both iCD-9-CM and ICD-10 codes. During the process, we learned that ICD-10-CM wasn't vastly dissimilar from ICD-9-CM. However, it was perceived that the ICD-10-PCS required a slightly different approach. Our team of trainers meticulously worked with the client's team and geared them to adapt to new changes. After the training, we ensured that their coders were competent to impart training to other coders who are striving to excel in the latest coding requirement.

We scheduled intensive training for 4 hours and the trainees were initially tasked to carry out rote functions.
We were successful in convincing clients to temporarily contract the existing tasks to coders until their n-house team completed the training. This move was planned to ensure committed efforts to learn the new codes and its application by their trainees.
Obfuscation in the ICD-10 was widely feared and we took it upon is to allay the fears while we strategized a method to tackle the complications. We initially focused on addressing manageable changes followed by the creation of General Equivalence Mapping (GEM) to map many ICD-9-CM codes to one ICD-10 code as well as one ICD-10-CM code.
The intensive training was followed by stringent auditing to ensure high-level accuracy in the coding. The coders were convened for weekly audits and persisting issues were remedied with a corrective plan, and further training was imparted by considering the individual review.

The Results

The solution that we devised helped the client to make a smooth transition to the ICD-10 system by meeting all compliances. The flawless transition was followed by higher accuracy and savings (40% revenue jump in the 6 months).

Outsource Medical Billing and Coding to Outsource2india - Leader in Healthcare BPO

Medical coding and billing challenges are diligently handled by highly specialized professionals back at Outsource2india. We are backed by 2 decades of experience in an array of healthcare BPO and have risen to client's expectation to deliver high-quality medical billing solutions. Our ISO 9001:2015 certified medical coding and billing services have led over 500 clients to streamline their revenue generation in quick TAT. We have global delivery centers and have options to work at your local time zones to provide a truly satisfying experience. The gamut of healthcare BPO services we offer includes claims adjudication, teleradiology, healthcare software, medical transcription, and more.