Case Studies

Comprehensive ICD-10 Implementation Support for a Florida-Based Medical Billing Firm


Based in Fort Myers, Florida, our client is a small-sized medical billing company established in 2005. They specialize in serving over 40 medical specialties and provide billing services to more than 20 hospitals across the US. Their monthly claims handling amounts to $900,000, showcasing their expertise in the field.

Despite their experience in medical billing and revenue cycle management, the company needed more coding expertise and was unprepared for the upcoming changes associated with ICD-10. They sought our proactive help to ensure a smooth transition and avoid potential productivity issues. They approached us to assist them in preparing for the implementation of ICD-10.

We meticulously trained staff in both ICD-9 and ICD-10, using an intensive approach with repetitive tasks and weekly audits to ensure accuracy. Our focused strategy and detailed mapping made the ICD-10 transition manageable and successful.

Story of the client

Located in Fort Myers, Florida, our client, a small-scale medical billing firm founded in 2005, caters to over 40 medical specialties. They extend their billing services to more than 20 hospitals across the United States, successfully managing a monthly claim volume totaling $900,000.

The client's services encompass various revenue cycle management solutions, ensuring accurate claim submissions, effective payment tracking, and seamless billing processes.

Despite their seasoned experience in medical billing and revenue cycle management, the company faced a challenge due to inadequate coding proficiency, particularly concerning the impending ICD-10 changes. Seeking proactive assistance, they approached us to facilitate their smooth transition and optimize productivity.

The Challenge

The client encountered substantial challenges as they aimed to transition smoothly to the ICD-10 coding system.

  • Ensuring client's preparedness within the grace period allotted by the Centers for Medicare and Medicaid Services for the ICD-10 transition.
  • Managing uncertainties during the live ICD-10 implementation, even with a well-structured plan.
  • Motivating coders to embrace training positively and invest sufficient time and effort for adequate preparation.
  • Reducing the learning curve to meet the impending deadline efficiently.

The Solution

In response to the complexities posed by the transition to ICD-10, we devised a comprehensive and proactive solution encompassing rigorous training, meticulous planning, and strategic management. Our approach was designed to ensure smooth adaptation and minimal disruption during this critical period of change.

Solution Highlights:

  • Early Preparation: Our team had prepared for the ICD-10 transition since late 2011, ensuring a solid foundation for the changes.
  • Expert Trainers: We assembled a team of trainers with deep knowledge of ICD-10 and years of experience in ICD-9 to guide and support the coding team.
  • Customized Training: Our intensive 4-hour training sessions, involving repetitive tasks, were meticulously designed to enhance learning and familiarity with new codes.
  • External Resources: To maintain focus on learning, we advised the client to hire contract coders while in-house coders received training.
  • Managing Changes: We focused on the more manageable changes first, creating General Equivalence Mapping (GEM) to assist coders in understanding code transitions.
  • Audits for Accuracy: A crucial aspect of our solution was conducting rigorous weekly audits to track issues, implement corrective actions, and provide education based on feedback.

The Result

Our partnership delivered tangible and impactful outcomes for the client:

  • Achieved a remarkable reduction in turnaround time to an impressive range of 12-24 hours.
  • Realized substantial cost savings, with a significant improvement of at least 40%.
  • Enhanced billing efficiency by an impressive 50%, optimizing financial processes

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