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They are numerous and formidable-and there will be more change in the next 2 years than our industry has seen in the last 20, says Bill Taylor, chief marketing officer, XIFIN Inc, San Diego. On the risk side, there is far more oversight by the US Department of Health and Human Services Office of the Inspector General, starting with Recovery Audit Contractors (RAC) demonstration projects that turned into the full-fledged RAC audit program.вЂќ - Bill Taylor, chief marketing officer, XIFINДЄ perfect storm of challenges faces clinical labs in the billing and coding arena. вЂњThe future of labs is now more risk and less reward. вЂњItвЂ™s much more precise data, in that it brings big challenges as well as big benefits.вЂќ

#CGM DAQBILLING SUPPORT PLUS#

вЂњOn the plus side, if a MRSA outbreak occurs, the statistics we gather with ICD-10 codes with billing data could help us to determine the source of the outbreak and track it,вЂќ Powell adds.

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вЂњBy increasing the code set, ICD-10 provides for needed expansion and logical grouping of codes by diagnostic category. вЂњFor instance, codes for many heart diseases increased enormously during the useful life of the ICD-9 coding system and could be impossible to find unless you know them by memory,вЂќ she says. And because ICD-9 and ICD-10 charges are so vastly different and have increased so much in number, a crosswalk feature is crucial to a successful transition to ICD-10 codes, Powell says. Other options include prescrubbing charges, editing data so itвЂ™s accurate and ensuring that charges will properly bill. And although billing is not done directly, the system can flow the information through to systems that do.

It uses data that has been gathered and passes it to other lab analyzers in an electronic format, and offers billing transcription reports that can be amended or corrected manually, if necessary. Merge LIS offers integrated interfaces with billing and diagnostic systems, and prescreens lab orders to avoid miscodings and other errors. Referring physicians get lab results faster, lab efficiency and test volumes are improved, automated processes allow for complete patient records, and there are short learning curves for new staff. Merge HealthcareвЂ™s Merge Clinical Lab Solutions (Merge LabAccess and Merge LIS) provide scalable laboratory information systems and middleware connectivity to lab instruments, automating the entire lab process and providing central point administration.

вЂњWe will be able to more clearly identify outbreaks by the use of more precise statistical data. вЂњFor example, take patients with an infection like Methicillin-resistant Staphylococcus aureus (MRSA),вЂќ she says. The new coding will be more specific to, and especially beneficial for, tracking specific disease. вЂњThis means that doctors need to be provided with the tools to help them transition from ICD-9 to 10. It quadruples the number of diagnostic codes, from about 17,000 ICD-9 codes to around 74,000 ,вЂќ Powell says. The solution? One option is systems that prompt physicians to include necessary data and that will not work unless such information is included. вЂњThis can impact reference labs and lab managers, as well as hospital labs, and the reimbursement delays can be enormous. вЂњSome smaller labs even hold specimens for as long as possible and donвЂ™t run blood tests until the proper information is obtained,вЂќ Powell says. The challenge of pulling this off successfully is the most significant one facing clinical labs today, according to Dianna Powell, presales clinical consultant for lab products, Merge Healthcare, Chicago.Д«ecause clinical labs can be a step removed from immediate and direct patient interaction and often donвЂ™t see patients or even medical records face-to-face, itвЂ™s even more challenging to include appropriate diagnostic codes on orders that donвЂ™t flow through to the laboratory information system (LIS) from hospital information systems (HIS) or electronic health record systems (EHR), she says.ДЄfter the fact, it can be even more difficult to get the necessary information. The transition to ICD-10 is required for all entities covered by the Health Insurance Portability and Accountability Act (HIPAA). On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. XIFINвЂ™s business intelligence mobile app.New Coding Offers Big Benefits

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