As the ICD-10 saga unfolds, providers and other stakeholders inevitably will find that the new codes are far more specific than ICD-9. And because of that specificity, simple mistakes could lead to reimbursement delays and claim denials. To get ahead of the game and prevent denials, you’ll need some type of quality control to keep those tiny—but potentially costly—errors from occurring. One way to do that? Hire an outside expert: an ICD-10-trained medical coder.
Coders fill many roles and can be a valuable asset to your clinic’s operations. According to American Academy of Professional Coders (AAPC), coders can do a great many things, including:
- Auditing and appealing denied claims.
- Educating providers, conduct chart audits, and recommend “appropriate application of federal mandates” and compliance regulations.
- Acting as an “advocate for the provider and patient” regarding coverage and medical necessity issues.
Quality coders have gone through extensive education to navigate the ins and outs of medical coding, and they’re primed and ready to catch mistakes—before your claims get denied. A qualified coder can take into account your patients’ health stories (as told by your documentation) to ensure your diagnosis code is accurate and justifies reimbursement. Bottom line: A true pro will help you get paid.
Weighing Your Options
Maybe you don’t see “hiring a coder” written in your clinic’s stars—but according to this report, you might want to alter your vision of your clinic’s future: “It is predicted that denial rates will increase by 100 percent to 200 percent post-implementation, with a corresponding increase in accounts receivable days by 20 percent to 40 percent.” As you consider the cost of hiring a coder for quality control, keep those ominous denial and AR timeline predictions in mind.
Something else to consider as you weigh the pros and cons of hiring a coder is the fact that therapists will only use a subset of the full 68,000-code library. With some preparation, your clinic just might be ready all on its own. However, if you’re leaning toward hiring a coder but the cost is still weighing on you, there is another route you can take: An alternative—and less expensive—option is to outsource to a third-party coding service.
Training Your Staff
Whether or not you decide to hire a coder, it’s imperative that you and your staff thoroughly train and prepare for ICD-10. The ICD-10 code set is a whopping five times larger than the ICD-9 set you’re used to—which surely will be a big bite to swallow. Here are a few digestible resources to get you started in your educational efforts:
There’s a lot to mull over to determine whether adding to your staff is the right decision for your clinic. But if hiring a coder seems like the right answer for you, remember that professional ICD-10 coders are in high demand—so you’ll want to start your hiring hunt sooner rather than later.
Would you consider hiring a medical coder? Share your thoughts below.