The client is a small medical billing company based in Fort Myers, Florida, specializing in more than 40 different domains. The customer established their company in the year 2005 and provides billing services to more than 20 hospitals in the United States. They handle claims worth $900,000 per month.
Although the company has extensive experience in medical billing, debt collection and revenue cycle management, they were struggling with the medical coding and lacked the required coding skills. Also, due to the introduction of ICD-10, they had to adapt to the changes to be introduced from ICD-10. After the implementation of ICD-10, they feared that their productivity level will be reduced. Hence, the client was not willing to wait for potential problems to appear, instead, they approached us to help them with the ICD-10 coding.
The biggest challenge we faced was training our client's team and ensuring that they are prepared during the extension period (the ICD-10 transition time given to change the codes). It was especially difficult when we were ready to change, and although we had a strong plan, we were not sure how it will work until we code in real time as per the ICD-10 protocols. Another key challenge was to encourage coders to be more actively involved in training and focus on taking the time and effort to prepare for the upcoming ICD-10 changes. At the same time, we had to make sure that the learning curve must not reduce so that we effectively meet the deadlines.
We believed that we would be able to manage the transition from ICD-9 to ICD-10 before the actual live date. We were ready to carry out the transition to ICD-10 from the end of 2011. When the customer contacted us, all our employees received training on ICD-9-CM and ICD-10. In the preparation process, we found that ICD-10-CM is not completely different from ICD-9-CM and can be easily learned. However, the same was not the case with ICD-10 PCS. Thus, we created a team of trainers who had gained in-depth knowledge of ICD-10 and years of ICD-9 experience. The team tried to identify coders from different areas of the client team who had a deep understanding of ICD-9 and were willing to accept changes. The goal was to ensure that they can personally help or train other coders to adapt to the new ICD-10 coding requirements.
From the beginning, we were clearly aware of one thing - intensive training. Therefore, we planned a timetable that included 4 hours of rigorous training for the participants and asked them to perform several repetitive tasks each day. We already convinced the client to hire contract coders, while we were in the process to train the internal coders. This way, we were able to ensure that the trainees continued to focus on learning new codes.
Eliminating the concerns related to ICD-10 was our number one priority, thus, we developed detailed methods to address this issue. Our priority was to focus on changes that were easier to manage. In addition, we created an equivalent General Equivalence Mapping (GEM), which includes how several codes of ICD-9-CM map only to one code of the ICD. This approach proved to be useful because the trainee gradually made changes and realized that the change was certainly controllable. Training was conducted through the same intensive audits to ensure an elevated level of accuracy. When we were set up at acceptable accuracy, we trained the coders for weekly audits. This helped us track down the problems, develop rectification plans, and give feedback-based training.
Our solutions helped our client in the following ways -
Flatworld Solutions is a leading healthcare support company for global medical organizations, providing healthcare support services, including ICD-10 transition & training services, health claims processing, medical billing and coding, AR management and follow-up, denial management, and other medical support services.
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