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Will Your Medical Billing Software Fail When the ICD-10 Grace Period Ends?
By Aiden Spencer

It seems like just yesterday the entire health care industry was thrown into total chaos at the announcement of the transition to the new ICD-10 codes. After many providers voiced their concern about the massive learning curve adopting the new codes would demand, the CMS granted a stay of execution in the form of a 12-month grace period.

The CMS grace period was a welcomed relief because it meant practices would still be reimbursed under Medicare Part B for claims that at least had a valid ICD-10 diagnosis code. This meant physicians and their staff could get up to speed without worrying about taking a huge hit to their revenue stream.

With only five months left until the grace period ends, industry experts are predicting that an ICD-10 crisis might still be coming for some providers. Will you be one of them? Are you currently implementing quality medical billing software, or will the system you're using fail come October 1st?

The importance of using the right medical billing platform for your practice cannot be overstated and should not be taken lightly. Particularly with potential reimbursement issues coming down the pike.

Here are some medical billing software features that will help your practice ensure payments come October 1st. If your current software doesn't currently offer these features, it may be time to consider shopping for a better billing solution.

Claims Scrubbing
When you submit a claim, you want to make sure it's squeaky clean. Resubmissions can be a time suck and clog up your revenue cycle. Since getting claims paid the very first time should be your top priority come October, and always, make sure your medical billing system has a claim validation feature that will help you spot rejected claims before you submit them.

Easy Interface
Five months from now you may find your billers curled up in the fetal position under their desk. While the grace period has kept anxiety at bay, for the most part, the pressure to get all of those codes correct is still a reality for many practices.

To make things as easy as possible for your billers, and to save valuable time, make sure your billing software is easy to use. Your staff shouldn't have to go through several menus to access information or perform a basic task. A few clicks is all it should take to input data and execute filings.

Proof of Filing
Your billing software should also be able to provide adequate proof that you submitted claims within required time limits.

You Choose the Clearinghouse
Good medical billing software allows you to choose which clearinghouse you use while subpar billing software will tie you to using their clearinghouse services. And they'll charge you a pretty penny for not providing you a choice. Make sure your software allows you to upload your claim files to the clearinghouse of your choice.

Electronic Remittance
Electronic remittance files (ERAs) provided by the insurance carrier can be a real time saver when your billers are posting payment information. Is your billing software able to import ERAs and post payment information for all of the associated claims paid by the payer?

Financial Performance Reporting
Come October 1st, it will be more important than ever to monitor the financial performance of your practice. Does your billing software offer a customizable reporting feature? Can you select date ranges and display data based on payer or receiver?

How Your Software Vendor Can Help
Your software vendor should be able to help you get ready for this new October 1st deadline so you don't suddenly experience revenue disruption. Here are some of the ways they can get you ready:

• Conduct an impact assessment. Last year the CMS had recommended providers evaluate the way in which the ICD transition would affect their practice. Did you take their advice, or, upon hearing you were getting a grace period, did you put off conducting an impact assessment inevitably? If you haven't conducted one yet, do so ASAP and ask your vendor for some guidance during this process.

• Recommend software upgrades. Has your vendor upgraded the system at all in the last seven months? Make sure you are up to date.

• Conduct testing. You should have conducted testing last year to prevent issues with delayed claims. Did you? Even if you did, it's still a good idea to run some tests before October 1st to ensure when the training wheels come off, so to speak, your revenue will not suddenly crash and require stitches. (Quick—what code is that?)

While you may still face some challenges in becoming fluent in ICD-10, your software vendor should continue to help you during this entire transition process.

Your medical billing software is a critical piece of technology to facilitate and monitor the revenue associated with your practice. If you have suspected that your system may not be up to snuff, now is the time to purchase a new solution, before October 1st comes around. While a quality billing software package may cost more upfront, ultimately it can save you greatly in the long run by making sure your claims are not rejected.

— Aiden Spencer is an HIT researcher and writer at CureMD who focuses on various engaging and informative topics related to the HIT industry. He loves to research and write about topics such as the Affordable Care Act, EHRs, medical practice management, and patient health data. You can get in touch with him on Twitter @AidenSpencer15.