We know what you’re thinking, “Not another meeting?!”

But yes, that’s what we’re here to talk about. Another meeting. Or, perhaps, how to make the most out of a meeting you already have – your monthly AR review meeting.

Monthly AR review meetings are critical to every skilled nursing facility, home health, or hospice organization’s financial operations. AR review meetings help your organization ensure that you collect the money you’re owed, efficiently utilize your staff, and prevent any recurring billing issues. These meetings are one of the best ways to ensure your AR strategy is quite literally paying off.

If you’ve ever led an AR review meeting, you know that it’s easy for these meetings to stall out and become unproductive. So, how do you keep your AR review meetings on track and productive? Here’s how to get started and six tips to help you lead a productive AR review meeting.

Setting up an AR Review Meeting

If your organization doesn’t currently have an AR review meeting or you’re ready to refresh your regular meeting, here are a few ways to get started:

Schedule your AR review meetings monthly to help ensure you’re making progress on unpaid claims and addressing recurring billing issues.

Consider having your financial administrator or executive lead the meeting.

Include all billing managers and any staff responsible for your AR in the meeting.

Tips for Leading a Productive AR Review Meeting

Now that you have your meeting schedule and the right attendees, it’s time to lead a productive AR review meeting. When preparing and leading your AR review meeting, here are six tips to help ensure you have a constructive discussion.

1. Identify Significant Accounts.

If your allotted meeting time doesn’t allow you to review all aged accounts, prioritize the accounts based on timely filing requirements, what has rolled from 60 to 90 days, anything over 90 days, accounts larger than $1,000, or accounts older than 120 days. If possible, have your billing staff work on these accounts at least once before your meeting.

Keep in mind that the accounts that continuously roll may not be getting worked or might be getting resubmitted for processing without identifying the root cause of the denial.

2. Have an Agenda and Planned Discussion Points.

A clear agenda is vital to ensure a constructive AR review meeting. The agenda should include reviewing your AR trends, an overview of your aging report, and the list of significant accounts that require review.

Here are some suggested account details you should plan to discuss:

The reasons the account is outstanding
An update on the progress made on the account since last month’s meeting
Plan of action for receiving payment

3. Facilitate a Constructive Review.

The most productive AR review meetings result from extremely positive thinking regardless of the negative subject matter of aging AR. Work together as a team to stay on topic, guard against disruptions, facilitate a constructive review, and ensure a clearly identified action plan.

It can also be helpful to drill into the root cause of unpaid claims instead of breezing through progress updates. Try asking specific questions about the data presented to determine the root cause of any issues. Here are some example questions you can try:

If payment has been received, why is there still a balance on the account?

Validate your payer contracts and ensure that the correct rates are billed.

What led to the facility writing off all or some of an account?

Understand why claims were not billed on time.

Why are there credit balances on an account?

Are there issues with coinsurance being booked to the wrong payer, cash posting errors, or problems with Medicaid not updating?

4. Create a Plan to Batch Work.

It may be impossible to work all of the necessary accounts. Instead, create a plan to only work on three to five accounts per week rather than trying to tackle the whole list. Working on a smaller list of accounts allows you to track incremental progress and delegate responsibilities.

5. Split Out the Remedial Work.

The action plan identified for your accounts can require a great deal of work. Try splitting out some of the more remedial work, such as checking a claim status or gathering medical records to other employees. This will free up your medical billers to focus on resolving the claim issues.

Should you need additional help, consider outsourcing your old AR collections to a medical billing company to help streamline your processes and improve your reimbursement.

6. Follow-up.

This last tip might seem like a no-brainer. But, regular follow-up ensures that any issues or roadblocks are addressed and allows key stakeholders to stay informed.

Alignment, Accountability, Action

An AR meeting that is consistent and structured will help you identify AR trends, delegate responsibilities, and prioritize work so that your team is efficiently tackling your aging AR. Now that you have prepared for a productive AR review meeting, you can collaborate as a team to collect what you’re owed as efficiently as possible.

MCA – Helping Advance your Revenue Cycle Management

Our unique combination of highly-skilled billers, long-standing SNF, hospice, and home health billing experience, and our dedicated support team makes MCA a reliable partner to help support your most complicated claims. If you’re ready to gain more insight on AR best practices or you could use additional support, drop us a note or call us at 866-609-5880 to learn more about how MCA can help.

Together, we can pave a better financial future for your facility.

About MCA Medical Billing Solutions

MCA is a full-service revenue cycle management company dedicated to helping skilled nursing facilities, home healthcare, and hospice organizations advance their revenue cycle management. We provide claims creation, submission, and follow-up to Medicare, Medicaid, and all commercial insurers.

When choosing MCA, you can expect experienced business insight, skilled billing intelligence, data extraction and management, and cloud-based documentation. MCA is here to help you streamline your revenue cycle process to produce consistent, high-quality outcomes.

An Essential Guide to the REVEX Bolt-on Services

Nowadays, growing and managing a successful SNF, home health, or hospice organization requires you to automate and streamline activities across the business. And your financial practices are no exception.

Financial process automation can improve your team’s efficiency, provide you access to critical managerial information, and increase your profitability. That’s why so many organizations have relied on our REVEX AR automation software. Automating your AR management with REVEX provides your organization with the real-time, interactive AR data you need to manage and grow a successful organization.

If you’re new to REVEX, learn more about how your team can experience a more innovative way to manage your AR in our previous blog.

Suppose your organization has been leveraging the power of REVEX for a while. In that case, you already know that the efficiency, simplified workflows, and accelerated collections available with REVEX are top-notch. But are you aware that REVEX offers 4 bolt-on services that can help you enhance your REVEX software experience?

Take your team’s efficiency to the next level with our essential guide to the 4 REVEX bolt-on services.

Essential Guide to the REVEX Bolt-on Services

REVEX provides your organization with the efficiencies of outsourced AR data management with the level of support that fits your needs. Whether you are using REVEX as a standalone AR tracking system or taking advantage of our investigation support or denial management, our 4 bolt-on services are always available. And, you can pick and choose which services you need.

Let’s take a deeper dive into the REVEX bolt-on services.

Text Statements to Patients

Expedite your patient’s collection, gain greater access to the financially responsible party, and improve your patient’s experience.

That may seem too good to be true, but with our text statements services, we send your patient statements directly to patients (or their financially responsible party) via text message. Statement notifications sent via text message allow the financially responsible party easy access to issuing payment without waiting on an email or paper statement. This on-demand service can help resolve open balances more quickly and improve the patient and family’s experience.

On-Demand Billers

Were you in need of medical billing staff…yesterday?

Our on-demand medical billers provide exclusive access to professional billers with experience in revenue cycle processes when and where you need them. Both providers and billing groups can utilize this service to scale their teams without investing in hiring internal staff or making costly contracts with other medical billing vendors.

Private Pay Collections

Collect more from your private pay accounts.

Turning over private pay accounts to a collection agency after it has become apparent that you’re not making any progress may help you recover around 14% of the accounts. With our private pay collections service, we help providers close at least 16.4%, if not more, of their private accounts. All while offering exceptional customer service focused on building and supporting a long-lasting relationship.

RAC Audit Denial Management

Prevent recoupments based on medical necessity.

Gain unrestricted access to our RAC audit professionals, who will carefully review the post-payment audits and coordinate a response for any missing information required for a response. Plus, they will track the progress of the audit to ensure the provider wins their appeal.

No matter what level of service your facility may require, you can expect that REVEX and our team of experts will support you. Start automating your AR or learn more about our bolt-on services by visiting mcarevex.com.

REVEX – AR Management Software

REVEX is a revolutionary AR management platform designed to help skilled nursing facilities and hospice and home health organizations streamline the management of their AR tracking process. By combining the control of in-house medical billers and the efficiency of outsourcing data processing, REVEX provides you with the real-time, interactive AR automation you need to manage and grow a successful organization.

Professional medical billers designed REVEX with extensive experience managing SNF, home health, and hospice AR. Our intuitive program provides a fresh approach to AR management software, allowing you to create streamlined workflows for your medical billers and insightful dashboards in minutes.

We begin by extracting your accounts receivable data from your patient management system and securely post it to our HIPAA-compliant portal. From our secured portal, you and your medical billers can access information and reporting that allows you to provide consistency and transparency in all you do.

Free up your medical billers to focus on more meaningful responsibilities and streamline your AR management by incorporating REVEX into your medical billing process.

The Value of REVEX

The key to a financially successful healthcare organization is efficient, automated AR management. REVEX helps remove any obstacles that prevent timely cash collections while enabling better communication and visibility your leaders need to monitor the organization.

With automated AR management and our optional bolt-on services, REVEX helps improve your cash flow, efficiency, transparency, and more.

Improve Cash Flow.

Increase cash and decrease days in AR with automatic daily claims updates and next step instructions on all denied claims

Boost Efficiency.

Sort AR by claim status, date of service, payor, amount, and urgency to manage, prioritize, and delegate accounts to specific billers.

Increase Transparency.

Know the status of any claim at any time with real-time notes and claim status updates accessible via our cloud-based servers.

MCA – Expert Help for Difficult Claims

Our unique combination of highly-skilled billers, long-standing SNF, hospice, and home health billing experience, and our dedicated support team makes MCA a reliable partner to help support your most complicated claims. When you leverage REVEX to help automate your AR management, the experts at MCA are just a click away. Free up your medical billers to focus on more meaningful responsibilities by incorporating REVEX into your AR management process.

Together, we can pave a better financial future for your facility.

Drop us a note or call us at 866-609-5880 to learn more about how MCA can help your SNF, hospice, or home health organization automate your AR management process. Plus, ask how you can use REVEX for free!

About MCA Medical Billing Solutions

MCA is a full-service revenue cycle management company dedicated to helping skilled nursing, home health, and hospice facilities advance their revenue cycle management. We provide claims creation, submission, and follow-up to Medicare, Medicaid, and all commercial insurers.

A fresh approach to AR management software.

Are you struggling to reduce your team’s time and effort on mundane, repetitive Accounts Receivable (AR) management tasks?

Do you lack the necessary visibility and tools to manage your AR effectively?

Are you trying to manage your AR on spreadsheets and work lists?

You’re not alone if you answered yes to any of these questions! Most skilled nursing facilities (SNFs), home healthcare, and hospice organizations lack the visibility and tools to manage their AR effectively. Spreadsheets are out of date the instant you create them, and work lists never provide the AR details your team needs to be fully effective.

The good news is that you don’t need to struggle any longer!

You can significantly improve your team’s efficiency, gain access to the details you need, and ditch those spreadsheets by automating your AR management with REVEX. Plus, you can increase your profitability!

REVEX – AR Management Software

REVEX is a revolutionary AR management platform designed to help skilled nursing facilities and hospice and home health organizations streamline the management of their AR tracking process. The REVEX software provides real-time, interactive information and reporting that allows you to provide consistency and transparency in all that you do.

We begin by extracting your accounts receivable data from your patient management system and securely post it to our HIPAA-compliant portal. From our secured portal, you and your medical billers can access real-time, interactive information and reporting that allows you to provide consistency and transparency in all you do.

Free up your medical billers to focus on more meaningful responsibilities and streamline your AR management by incorporating REVEX into your medical billing process.

REVEX Solutions for Your Business

By combining the control of in-house medical billers and the efficiency of outsourcing data processing, REVEX provides you with the real-time, interactive AR automation you need to manage and grow a successful organization.

Our software provides everything you need and nothing you don’t. The automation available with REVEX helps you to boost your efficiency, simplify your workflows, and accelerate collections. Some of our comprehensive features include:

Red Flag Alerts.

Set aside the most important claims for the customer using our integrated flagging feature allowing your team to stay on track with alerts and escalations.

Embedded Reporting.

We use our simplified, value-rich AR aging reports to identify what is collectible or what claims require adjustments. The information you need is available at a glance or in more detail when you need it.

Easy and Intuitive Software.

Input processing notes and collection status with our easy and intuitive data collection process, improving cross-departmental workflows and efficiency.

Access Anytime, Anywhere.

Get real-time access to your AR information anywhere and anytime from your mobile device or an application on your desktop.

The REVEX Value

With automated AR management from REVEX, you can improve your cash flow, efficiency, transparency, and much more.

Improve Cash Flow.

Increase cash and decrease days in AR with automatic daily claims updates and next step instructions on all denied claims

Boost Efficiency.

Sort AR by claim status, date of service, payor, amount, and urgency to manage, prioritize, and delegate accounts to specific billers.

Increase Transparency.

Know the status of any claim at any time with real-time notes and claim status updates accessible via our cloud-based servers.

REVEX Service Plans

REVEX provides your organization with the efficiencies of outsourced AR data management with the level of support that fits your needs. Incorporate REVEX into your AR management process and experience a more streamlined, efficient, and transparent AR management right away.

We offer a REVEX service plan that’s right for every business.

REVEX Foundation

Stand-alone AR tracking system
Claims upload support
Standard workflow configuration

Investigation Support

Everything from the REVEX Foundation services plus
General claim follow-up
Action and next step guidance

Denial Management

Everything from the Investigation Support service plus
Corrects and adjustments on all AR
Appeals and reconsiderations

No matter what level of service your facility may require, you can expect that REVEX and our team of experts will support you. We’re committed to your success. But, you don’t have to take our word for it. Check out what our customers have to say:

“We run REVEX on all our accounts which makes tracking and collecting them a breeze. If I ever have a question about an account, I just click it, and it works and is resolved within 48 hours. It’s amazing!” Brett, Summit Healthcare

“REVEX is awesome; I love using it. I log in for less than 30 minutes daily, and the AR stays clean. It allows us to keep our existing billers but makes them much more productive, so we need less of them…” Jackie, Method HC

MCA – Expert Help for Difficult Claims

Our unique combination of highly-skilled billers, long-standing SNF, hospice, and home health billing experience, and our dedicated support team makes MCA a reliable partner to help support your most complicated claims. When you leverage REVEX to help automate your AR management, the experts at MCA are just a click away.

Together, we can pave a better financial future for your facility.

About MCA Medical Billing Solutions

Are you struggling to keep up with timely patient statement distribution?

Is your call center overwhelmed with billing questions?

Unfortunately, patient statement distribution, payment collection, and call center support aren’t going away. And for SNFs, hospice, and home healthcare, it can be challenging to stretch your resources to deliver the services your patients expect efficiently and quickly.

So, it’s understandable if you’re struggling to keep up with the growing demand for statement delivery and call center support.

But, there is some good news!

Outsourcing your statement distribution and call center support can help you expedite collections and improve patient satisfaction, regardless of the size of your facility.

Statement Distribution and Call Center Support

It’s critically important for your facility that your patients receive accurate and precise statements quickly. In addition, you want to provide excellent customer service to address any patient billing inquiries. But, with limited staff, it can be hard to deliver the services your patients and their families expect.

It doesn’t have to be this way.

With support from an experienced medical billing company, you can deliver easy-to-understand statements and provide professional support for your patients.

Discover How MCA Can Help

Outsourcing statement distribution and call center support can give you the peace of mind that your residents are receiving consistent service while increasing your collections. When outsourcing your statement distribution and call center support to MCA, we manage the entire statements distribution process to patients, including taking calls from your residents regarding statement questions.

By selecting MCA to manage your statement distribution and call center support, you can expect:

Easy-to-understand statements.

MCA is committed to providing detailed, easy-to-understand statements that provide your residents with the information necessary to expedite outstanding payments.

Our billing professionals will consistently handle all the little details necessary to produce and distribute your billing statements with clearly written payment instructions.

Updated facility and ancillary charges included.

Before any statements go out to your residents, MCA’s highly skilled medical billers ensure that all submitted statements contain updated facility and ancillary charges. We work to identify and verify all charges to minimize the number of statements your residents and their families receive.

And we mean every charge! We aim to ensure that a submitted statement contains everything necessary to articulate the current amount due and due date.

Timely statement submission.

MCA facilitates a faster statement process and delivery by providing multiple statement delivery methods, including digital notifications and statements in addition to print statements to prompt more immediate patient responses. Our highly efficient statement processing means that you can get your statements delivered quickly. And getting your billing statements out swiftly and efficiently means you get paid faster and more often.

Integration with your facility’s system.

There is no need to log in to yet another system. When outsourcing your statement distribution to MCA, we integrate with your facility’s system to help ensure accurate and timely statement submissions.

Triage and resolution of patient statement concerns.

MCA’s dedicated support team fields all statement-related questions. Our team triages the patient’s or family’s statement concerns and works with your facility to ensure an accurate and timely resolution.

We’ll stay on the phone with the patient or family member and help resolve their concerns. Our detailed knowledge of the billing and your system allows us to resolve more issues over the phone, helping accelerate patient payment.

Statement Distribution and Call Center Support Is One of Our Specialties

There’s no denying that managing statement distribution and billing questions take a great deal of time! Time that your administrative team could be spending on higher value tasks.

MCA’s dedicated team of skilled medical billers and our support team are exceptional at managing statement distribution and call center support. Our team is extremely knowledgeable and incredibly patient – helping to provide your patients with the communication and customer service they deserve.

With help from MCA, you can free up your administrators. You can save money and improve your facility’s cash flow.

Save Time

Your team works hard to keep your statement distribution process and call center running smoothly and efficiently. Removing the tedious task of medical statement processing from their list will free up their time to focus on other, more critical tasks.

Accelerate Patient Payments

Accelerate patient payments with accurate, easy-to-understand print and digital statements.

Simplify Your Mailing Process

Eliminate time-consuming printing, folding, and stuffing, by letting MCA print and mail statements for you. Plus, you can get rid of the large inventory of mailing supplies and obtain postage discounts and faster processing.

Provide the Customer Support Your Patients Expect

MCA is an extension of YOUR staff and representatives, providing your patients exceptional customer support. We’re dedicated to answering your patient’s and family’s questions while on the phone. And when we can, we partner with you to ensure nothing goes unanswered.

Get Support That Works

Gain access to a team of experts dedicated to helping you improve your statement distribution process and your call center support. But, don’t take our word for it.

“The MCA staff were very knowledgeable and professional when I called them about my statement”

Independent Living Resident- Wichita, KS

“MCA is not just a call center, they have their billing managers take calls so they can answer all your questions about your statement.”

Admin- CCRC Overland Park, KS

MCA – Expert Help for Statement Distribution and Call Center Support

Our unique combination of highly-skilled billers, long-standing SNF, hospice, and home health billing experience, and our dedicated support team make MCA a reliable partner when outsourcing your statement distribution and call center support.

Together, we can pave a better financial future for your facility.

Drop us a note or call us at 866-609-5880 to learn more about how MCA can help your skilled nursing facility clean up your aging AR.

About MCA Medical Billing Solutions

Does it feel like your SNF’s aging AR is unmanageable or trending that way? Do you feel like your team is working harder and receiving lower reimbursement?

Unfortunately, SNF aging AR collection is not getting any easier. There are changing government guidelines, increased numbers of residents requiring specialized care, and low reimbursement rates.

On top of that, there is a good chance that after you’ve cared for your residents and their families, the billing process won’t go as smoothly as you’d like. Unless you have direct oversight of every step in your collections process. But who has the time and energy for that?!

So, it’s understandable that your aging AR has gotten out of hand. Or your days in AR are creeping up.

But, there is some good news!

You can improve your AR collections and decrease your AR management costs! You can improve your reimbursement by streamlining your processes and putting a team of skilled medical billers to work. Bonus, you can recapture revenue that you previously had to write off.

SNF Aging AR Collections

Many SNFs get stuck untangling their AR aging report or are too busy to work on their aging accounts. They reach for the most straightforward solution…writing off their aging AR.

With a strategic plan and support from an experienced medical billing company, you can get your aging AR cleaned up. Many SNFs will see an injection of cash and decrease days in AR in as little as 30 days.

Discover How MCA Can Help

Outsourcing support to clean up your aging AR can provide you with the peace of mind that your business office is running like a well-oiled machine. When outsourcing your aging AR management to MCA, our skilled medical billers will review your AR and provide solutions to streamline your processes and improve reimbursement.

By selecting MCA to manage your aging accounts receivable, you can expect:

A Methodical Evaluation of Your Current AR

When MCA takes on your aging AR collections, our first step is to complete a systematic review of your unresolved claims and a complete AR analysis. We work to identify every recoverable claim so that we can get to work on it.

And we mean every claim! Our goal is to find the most opportunities for reimbursement possible. Whether from high-dollar medical claims or more minor claims, they all add up for our customers.

A Prioritized Plan to Optimize Recovery

MCA’s highly skilled medical billers establish a prioritized plan to ensure that we optimize your potential recovery from your aging AR. We ensure that all qualified claims are corrected and scheduled to pay before they reach “Timely Filing Limits”.

Our proprietary AR management software, REVEX, allows us to manage, prioritize and delegate accounts to optimize your recovery. We can prioritize your AR by claim status, date of service, payor, and amount of urgency to ensure collection on all possible accounts.

Successful Claims Correction and Resubmission

Our dedicated billers work to ensure that every claim is reviewed, corrected, and resubmitted when necessary. And we help to identify the reasons that may have caused your errors so that you can eliminate them in the future.

But, we don’t stop there! After making any necessary corrections or clarifications, we work to appeal those claims with the insurance company or government payor to ensure revenue recovery.

Aging AR Collections is One of Our Specialties

It’s a well-known fact that the longer a bill goes unpaid, the less likely you’ll be able to recover any revenue from it. Outstanding claims lead to a tremendous amount of lost revenue every year.

MCA’s dedicated team of skilled medical billers are exceptional at collecting on what others may consider uncollectible. But, rather than giving up on your aging AR, our team can help you take immediate action towards identifying, investigating, and resolving your unpaid claims.

With help from MCA, you can stop stressing about your aging AR. You can decrease your write-offs and positively impact your SNF’s bottom line.

Save Time and Increase Efficiency

You’ll no longer need to reactively chase outstanding payments and utilize valuable team members to manage your aging AR. Instead, you’ll be able to follow a streamlined plan that allows you to save time and increase the efficiency of your staff.

Recapture Earned Revenue

Increase your cash flow and instantly become more profitable with an immediate reduction in aging AR.

Receive Cleaner and More Meaningful AR Reports

No more overwhelming, unmanageable AR reports. You’ll receive a clean, action-oriented AR report that will provide meaningful data to identify trends and concerns.

Get a Proven Model That Works

Gain access to a team of experts who utilize a proven aging AR collection model that works. Don’t take our word for it. Take Chris, Diane, and Andrew, for example.

MCA helped us collect $450K in old Medicare and Managed Care claims within the first 90 days of our engagement. Allowing us to reduce our days in AR by 7 days.

Chris from Manhattan

We had $425K in old Medicare, Managed Care, and Medicaid claims, and within our first 60 days of working with MCA, we collected our outstanding payments and reduced our days in AR by 5 days.

Diane from Washington DC

Within our first 60 days of working with MCA, we collected $300K in old Medicare and Medicaid claims allowing our internal billers to focus on our current claims.

Andrew from Illinois

MCA – Expert Help to Collect On Your Aging AR

Our unique combination of highly-skilled billers, long-standing SNF billing experience, and proprietary technology makes MCA a reliable partner in recovering your aging AR.

Together, we can pave a better financial future for your skilled nursing facility.

Drop us a note or call us at 866-609-5880 to learn more about how MCA can help your skilled nursing facility clean up your aging AR.

The World Health Organization’s (WHO) International Statistical Classification of Diseases and Related Health Problems (ICD) is a globally-recognized diagnostic tool for epidemiology, health management, and clinical purposes. ICD provides a systematic approach to coding, reporting, analysis, interpretation, and comparison of mortality and morbidity data.

As of January of this year, the WHO began accepting codes for the 11th revision of the ICD, or ICD-11. This updated version helps address gaps in ICD-10 and incorporates updates that have become standard practice in modern-day healthcare.

As with ICD-10, ICD-11 will impact medical coding and billing in all specialties. There will be added complexities for some, while others will find consolidated operational enhancements.

Let’s begin by breaking down the purpose of ICD-11, the key differences from ICD-10, and when ICD-11 will be released in the U.S.

Why Did The WHO Revise ICD-10?

ICD-10 was initially accepted by the WHO in 1989 but was not fully implemented in the U.S. until 2015. Despite several updates, ICD-10 had become clinically outdated, and many of the chapters required structural changes.

Additionally, ICD-10 presented limitations in enhanced electronic environments and limited information for some morbidity-use cases.

To address the issues with ICD-10, the WHO included the following goals for ICD-11:

1. Ensure ICD-11 functions in an electronic environment by:

Providing a digital product
Outlining linkage with terminologies such as SNOMED
Defining ICD Categories by “logical operational rules” on their associations and details

2. Provide a multi-purpose, coherent classification for mortality, morbidity, primary care, clinical care, research, and public health with consistency and interoperability.

3. Deliver an international, multilingual standard for scientific comparability in English, French, Spanish, Russian, Chinese, and Arabic.

What Are the Differences Between ICD-10 and ICD-11?

According to the WHO, ICD-11 is a scientifically rigorous product representing modern-day health and medical practices.

What are the differences between ICD-10 and ICD-11? Here are a few of the main differences:

Coding Structure: ICD-11 increases specificity and flexibility with a more sophisticated categorization and coding structure than ICD-10.

Increased Diagnoses and Conditions: ICD-11 includes more diagnoses and conditions permitting categories of severity, course, and specific symptoms to be added to diagnoses.

Digital Readiness: ICD-11 was designed to be electronic to help streamline processes and increase operational efficiencies utilizing the latest technologies.

Global Application: ICD-11 offers guidance for different cultures and has been translated into 43 other languages to increase standardization and collaboration internationally.

ICD-11 Basic Code Structure

ICD-11 has added a significant number of diagnoses and chapters so medical billers can become more granular and accurate in their submissions. The ICD-11 diagnostic codes are alphanumeric with a letter in the second position to differentiate them from the ICD-10 codes. In addition, the first character indicates the chapter. For example, 2A00 is a code in Chapter 2.

One of the most significant updates from ICD-10 to ICD-11 is cluster coding. Cluster coding allows coding professionals to link codes together to fully describe a clinical condition.

The following example shows the difference for Diabetes mellitus, type II, with left diabetic cataract for ICD-10 and ICD-11.

ICD-10-CM 2021: E11.36 Type II diabetes mellitus with diabetic cataract

ICD-11: 9B10.21&XK8G/5A11

9B10.21 Diabetic cataract

XK8G Left

5A11 Type 2 diabetes mellitus

When Can The U.S. Expect a Release Date for ICD-11?

Don’t panic yet! Even though ICD-11 took effect on January 1, 2022, the National Committee on Vital Health and Statistics (NCVHS) has not finalized an official rollout timeline for ICD-11 in the U.S. The NCVHS expects that ICD-11 will be released in the U.S. as early as 2025 or delayed to 2027 if a Clinical Modification set is required.

ICD-11 Fast Facts

ICD-11 provides an up-to-date and clinically relevant classification system that results in data that can design effective public health policies, measure policy impacts, or for clinical recording.

The following are 10 ICD-11 Fast Facts

1. ICD-11 includes 17,000 unique codes and more than 120,000 codable terms.

2. ICD-11 contains 26 chapters, five more than ICD-10

3. ICD-11 is built as a database accessible via a web platform (no more books) to support the use of electronic health records. This allows for the flexibility to grow and change the online content with medical advances.

4. ICD-11 will create changes in the coding systems for most healthcare organizations because it will connect with various EHRs through the SNOMED CT Foundation.

5. ICD-11 includes a proposal platform that allows users to suggest changes or additions to ICD-11.

6. Codes for patient safety documentation are in line with the WHO patient safety framework.

7. Necessary detail for cancer registration is fully embedded in ICD011.

8. ICD-11 provides more clinically relevant coding for complications of diabetes.

9. In response to the COVID-19 pandemic, emergency codes were added to ICD-11 to confirm the diagnosis of COVID-19, classify post-COVID-19 conditions, establish COVID-19 as the cause of death, and record COVID-19 vaccinations and any adverse reactions.

10. ICD-11 can be used online or offline using free container software.

How MCA Can Help You Prepare for ICD-11

Our unique combination of highly-skilled billers, long-standing SNF billing experience, and proprietary technology makes MCA a reliable partner for your transition to ICD-11

Drop us a note or call us at 866-609-5880 to learn how MCA can help your skilled nursing, home health, or hospice facility manage the upcoming ICD-11 transition.

About MCA Medical Billing Solutions

MCA is a full-service revenue cycle management company dedicated to helping skilled nursing facilities advance their revenue cycle management. We provide claims creation, submission, and follow-up to Medicare, Medicaid, and all commercial insurers.

Resources

WHO ICD-11 Fact Sheet

WHO ICD-11 2022 Release Updates

WHO Classification of Disease (ICD)

National Committee on Vital and Health Statistics