FWA Briefs

Find news and solutions for healthcare payers and providers. Recognize and avoid potential fraud, waste, and abuse scenarios. Real-time clinical claim editing are analyzed to maximize provider reimbursements.

Outsourced Coding Vendors Face ICD-10 Challenges Related to Transition

  • by Margaret Klasa DC, APN BC
  • Oct 29, 2015, 11:31 AM

Context Coding SolutionsThe October 1, 2015 implementation date for ICD-10 has finally come and gone. While many industry experts had predicted complete chaos, shut-downs and major loss of productivity, as we enter the last week of October, only some of those predictions have come to fruition. It has been extremely quiet on both the provider and payer ends in the month of October. Some have even suggested that all these predictions of doom have come to resemble the Y2K nightmare that never materialized. Or it could be that many providers have not billed out their normal volumes yet and payers have yet to dispense those denials? Productivity levels have been impacted as the codes themselves are numerous and documentation from physicians had to be altered. We may be hearing more grumbles as providers submit more and more bills with the new codes, especially for Medicare services rendered. One noted area that has come to attention regarding the ICD-10 transition is outsourced coding.

In a recent article posted by ICD10 Monitor and authored by an anonymous overseas physician, it is noted that many providers fearing major revenue loss associated with the ICD-10 coding transition, opted to outsource their ICD-10 coding workload.1 Those outsourced workloads are handled by coding vendor companies located outside of the U.S. that may not be prepared to handle their business.

It appears that the working conditions in some off-shore areas where coding vendor companies are located are causing talented coders to walk off the job thus leaving new coders to handle the workload. Those countries with marginal labor laws have required coders to work overtime as well as one day during a weekend. Additionally, some coders are using old resources such as coding books from 2014. In healthcare billing and coding, the resources such as code sets, fees medical necessity and regulations are constantly changing. Newly trained off-shore coders are not aware of code first scenarios such as includes and excludes codes that should be analyzed and utilized and are completely different from the previous ICD-9 coding system. Rushing to complete claims without reviewing charts leaves insufficient code captures and thus loss of revenue and could mean medical necessity denials due to unspecific code usage and even raise the likelihood of an audit.

Context4 Healthcare, Inc. can offer a simple solution to prevent the use of outdated coding source materials and up to the minute coding information – CodeLink® Pro. Not only does CodeLink Pro offer ICD-9-CM to ICD-10-CM cross referencing based on the Center for Medicare and Medicaid’s General Equivalency Mapping but provides information on the precise codes and claim information selected by the user including the entire listing of CPT®, HCPCS, ICD-9 & 10-CM codes, notes, include and exclude notes and linkage libraries – CPT® and ICD linkages based on physician specialties. CodeLink Pro specifically addresses utilization, validation, modifier usage, and the National Correct Coding Initiative (CCI) edits for unbundling and potential upcoding occurrences.

Context also offers the ICDTransformer™ solution which is a real-time web service that can be integrated into any system requiring the transformation of an ICD-9 code to ICD-10. Our solution is highly scalable, with a straight-forward integration to your existing application, whether it's an EHR/EMR, a practice management, or a claims adjudication system. Your volume and speed requirements are met.

The ICDTransformer solution is state-of-the-art technology that uses a proprietary knowledgebase created by our highly experienced clinical coding team. The unique methodology reviews the ICD-9 codes your doctors, coders, and billing staff are accustomed to, identifying key pieces of the service to pick the proper ICD-10 code. Best of all, this means no immediate changes or disruption to office policies or productivity.

The ICDTransformer analyzes: 

  • The ICD-9 diagnosis code
  • The rendered service 
  • The laterality 
  • The body part 
  • Search words provided by the user

CPT® is a registered trademark of the American Medical Association | Copyright 2014, American Medical Association | All rights reserved

Source1: http://www.icd10monitor.com/enews/item/1514-offshore-coding-week-1-chaos

Subscribe to Our Blog:

Connect With Us


Posts by Topic

Proudly Affiliated with:

Proud_Members_Logo_250X100   National Association of Dental Plans Member   FedRAMP  Amazon Web Services