4 Medical Billing Changes to Prepare for in 2014


A new year always brings hope of added growth and renewed prosperity. And 2014 should be no different.

However, for physicians to maximize reimbursements in the coming year, they’re going to have to adopt a series of changes in their billing and coding protocols.

Today, we’ll take a look at the four most important billing modifications physicians will have to make in 2014 to maintain a healthy revenue stream.

1. ICD-10 – That’s right. The long-anticipated, new International Classification of Diseases code set will finally take effect on October 1, 2014.

Under ICD-9, medical coders currently work with roughly 13,000 diagnosis codes. That amount will increase to approximately 70,000 diagnosis codes once the switch to ICD-10 is made. Add these to the new procedural codes and the total comes to almost 155,000 codes.

Healthcare providers should expect potential billing and coding impediments and possible profit reductions during this massive healthcare billing overhaul. You’ll have to start training for the switch as soon as possible to help reduce the impact.

If you still think you won’t be able to keep up with the thousands of new diagnosis and procedural codes, maybe it’s time to consider outsourcing your medical billing to a third-party revenue cycle management solution.

2. Healthcare Exchanges (HIX) – How HIXs will set payment rates is still an uncertainty, but some states are already aligning with Medicaid prices, resulting in lower reimbursement rates for doctors. Couple lower payments with an influx of thousands of new patients and practices are facing some serious jumps in costs.

Mitigate underwhelming reimbursements by implementing new technologies like EHRs and comprehensive practice management solutions that streamline your workflow and help move patients through your practice faster, a quality that will be vital as you look to take in more patients to cancel out decreases in revenue.

3. Revised CMS 1500 form – The Centers for Medicare and Medicaid have released a revised claims form that will be distributed for use on January 6 and become mandatory by April 1. The new form has been created to accommodate ICD-10 come October. Check with your payers for their projected effective dates.

4. CPT code changes – The American Medical Association’s current procedural terminology code set will experience a massive overhaul at the start of next year. In September, 353 changes were announced, many of which pertain to technology improvements.

“The CPT code set is the foundation upon which every element of the medical community — doctors, hospitals, allied health professionals, laboratories and payers — can efficiently share accurate information about medical services,” said AMA President Ardis Dee Hoven, M.D.

“The latest annual changes to the CPT code set reflect new technological and scientific advancements available to mainstream clinical practice and ensures the code set can fulfill its vital role as the health system’s common language for reporting contemporary medical procedures.”

This is considered to be the largest CPT code modification in years. The 2014 CPT codes and descriptors can be purchased and imported directly into existing claims and billing software using this downloadable CPT 2014 Data File.

Ultimately, physicians have to prepare for these billing changes if they want to keep receiving the appropriate reimbursements for services rendered. Make sure your billing department is up to speed on all modifications resulting from the Affordable Care Act and other HHS overhauls in 2014.

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