ICD-10 and HITECH compliance key issues for medical billers

by Healthcare IT News

ICD-10 implementation and compliance issues associated with the HITECH Act are on the minds of medical billing companies, according to a speaker at the 2009 Fall National Conference of the Healthcare Billing and Management Association.

Holly Louie, compliance officer at Practice Management, Inc., a Boise, Idaho-based multi-specialty billing company, spoke Wednesday at a pre-conference compliance session at the HBMA conference in Las Vegas. She presented jointly with Karen Collier, corporate compliance and privacy officer at Oklahoma City-based Medical Consultants, Inc.

The HBMA is the only trade association representing third-party medical billers in the United States. Louie chairs the organization’s Ethics and Compliance and ICD-10 committees.

In an interview with Healthcare Finance News, Louie addressed the hot topics that HBMA members would be discussing at the 2009 annual conference.

What are third-party medical billing companies going to be talking about at this year’s HBMA conference?
"I think the ICD-10 5010 implementation and the HITECH Act will be central topics of discussion. There are many other very important compliance topics, but these two have the most immediate operational impact on HBMA members. They will demand the biggest changes in costs, training requirements and daily operations for billing companies."

With regard to ICD-10, do you expect that there will continue to be delays in implementation?
"That depends on whom you ask. (The Centers for Medicare and Medicaid Services) has said there will be no delays, but there are a lot of issues involved. If you look at where the industry is in regard to preparation, what needs to be accomplished and some of the hurdles to implementation, I frankly don’t see how there won’t be delays. However, we are encouraging our members to prepare as best they can.

Some of our members attended the WEDI meeting in August, and the commercial payers have been very candid. They are not going to convert immediately. Instead, they plan to use crosswalks, mapping and internal translation tables for an indefinite period of time, while they try to build a database that they can utilize with ICD-10 codes. That sounds fine until you realize how many commercial payers there are in the United States. If each payer builds their own idiosyncratic crosswalk, it could make claims processing absolutely chaotic for providers.

One of the things I would like to see is a finite number of approved mapping programs. The reality of ICD-10 implementation in the U.S. is going to be more challenging than the history of ICD-10 implementation around the world, which has been predominantly in single-payer, government payer, countries with very limited data sets that are used only for reimbursement on the inpatient hospital side. That’s not the situation in the United States. However, even given the problems, you can’t assume that implementation will be delayed, and billing companies could be in trouble if they’re not prepared."

What are some questions and concerns that third-party billing companies have in regard to fraud recovery actions?
"The biggest concern this fall will be on the RAC rollouts. The biggest worries are: (1) what will the RACs target, (2) will the process be fair, and (3) will you really have an opportunity to appropriately defend yourself if you disagree with the RACs. Unfortunately, it’s our provider clients who will be hurt by the RACs, but billing companies are the ones accountable to respond to RAC reviews and to help their clients. It’s a big concern for many HBMA members."

What concerns do third-party billers have about the HITECH Act and some of its compliance requirements?
"HBMA has done Webcasts on the need for billing companies to re-do their risk assessment in light of the HITECH Act and to document their compliance with the security measures that must be in place. Some of our smaller members are struggling to find appropriate encryption programs to use. A lot of our smaller, more rural, members are dealing predominately with paper documents, and those can’t be secured, so it’s a real problem. They’re looking for innovative solutions on how to make the transition to electronic encryption security. We have had a lot of questions about educating employees on the security issue. We’re trying to help our members train their staff on what to do if there is a security breach. Third-party billers need to know how to work with other entities when they will be required to transmit data back and forth on a regular basis.