By now, you’re probably bracing your practice for the conversion to ICD-10 code sets. Maybe you’ve even already budgeted for the major initial costs.
But even if you’re well prepared for the technology purchases and administrative training time the switch will require, ICD-10 could still hurt you if you’re not aware of its potential consequences.
Minimize the negative impacts ICD-10 could inflict on your practice by learning the drawbacks now. Here are five pitfalls to prepare your practice for.
1. Physician Incompatibilities
Most practices are anticipating the amount of training the ICD-10 conversion will require their support staffers to undertake. Learning to utilize roughly 150,000 codes instead of 18,000 is going to take billers and coders 50 to 100 hours each.
But there’s another important person who will need training that you may not have considered yet – the doctor.
Physicians must be educated on the changes ICD-10 brings. Some will even need to adjust their documentation routine to comply with the modified coding procedures.
The ICD-10 codes are so particular that if a doctor doesn’t notate all aspects of a patient visit, an encounter could end up improperly coded and misbilled.
“You can’t code what isn’t charted,” says Cynthia Grant, director of Courtyard Group, a consultancy firm experienced with ICD-10 implementation. “You need to know where the pain in the limb is and also whether it’s on the left or the right. If you’re simply coding pain in the limb – unspecified – you could be leaving money on the table.”
Physicians who don’t learn the essentials of the new code sets might omit specifics from their notes and get lower reimbursements. Plan ahead for physician ICD-10 training.
2. Slowed Productivity
During the short-term period of your ICD-10 transition, the hundreds of hours your staffers (and doctors) spend in training will be time they don’t spend performing their usual duties.
In the long term, the increased detail of the code standards means that more thought and effort must go into the assignment of every code and patient visits may take longer.
Post-conversion, coders will likely need to frequently ask questions of physicians to verify information, causing submission delays. Or, should they neglect to ask and thus exclude necessary details, there will be an increase in claim denials for insufficient information.
All of those factors will add up to slow overall productivity when the move to ICD-10 becomes a reality.
Managers of Canadian medical offices and hospitals, which changed over to ICD-10 in 2004, say that coder productivity went down with the onset of ICD-10 and has yet to return to ICD-9 levels.
U.S. physicians and practice managers should be prepared for decreased productivity to result from ICD-10 and brace for the financial impact of lower coder output.
3. Dual-Format Processing
You may want your coders to stay late on Friday, September 28, 2013 and get the last of the month’s claims submitted in ICD-9. The requirement that claims go out in ICD-10 beginning October 1 is mandated by the date of service of the claim, not the date of transmission.
So if your billers get behind in dispatching pre-October claims, they’ll be working in both formats until they’re caught up. For a while following ICD-10 conversion, both code sets will be in effect for claim adjudication and reimbursement.
“Older claims might be in play for months after Oct. 1, 2013,” says Ken Bradley, VP of Strategic Planning at Navicure, a clearinghouse. “That’s what concerns me most. Practices will have to deal with claims rejected, denied and appended in both systems.”
If your coders usually juggle multiple weeks of encounters at once, make certain your billing software can accommodate simultaneous processing of ICD-9 and ICD-10 codes come October 2013.
4. Reimbursement Uncertainties
There’s an overall sense that ICD-10 will not alter provider reimbursement levels, but that confidence in payer system integrity may be unwarranted. One healthcare company called that assumption an “ICD-10 Transition Myth.”
Proponents of ICD-10 implementation say that the greater granularity of the code sets will result in more accurate reimbursements, touting that as a boon to providers and payers alike.
That may hold true as a positive long-term outcome. But a more accurate reimbursement for a procedure might be a lower reimbursement than is expected under present code set standards. That’s scary for budget plans in the short term.
Be aware that the move to more precise reimbursements may not be immediately beneficial to your practice during the ICD-10 conversion’s aftermath.
5. Stalled Cash Flow
Your practice won’t be the only one managing the consequences of the code set changeover. The ICD-10 fallout will affect the entire healthcare ecosystem and will likely slow the inflow of money to your office.
“There could be an increase in claim errors and delays as coders, physicians, and payors are adjusting to the new methodology,” writes blogger Jessica Berens in a post on ICD-10 challenges.
In addition, the effects of all of the ICD-10 consequences listed above may combine to put your financial operations on pause – or maybe just slow motion.
Though no one can perfectly predict the outcomes of the ICD-10 future, today it seems like the aftereffects will be far-reaching for medical practices.
Educate yourself of on ICD-10 and get a head start on your implementation arrangements. Look forward, plan ahead and save up to avoid ICD-10 surprises.
How prepared are you for ICD-10’s drawbacks?
Madelyn Young is a Content Writer for CareCloud and an expert on practice management, medical billing, HIPAA 5010, ICD-10 and revenue cycle management. You can read her work on Power Your Practice and the CareCloud Blog. Contact Madelyn with story suggestions, contributor articles, or any other feedback at madelyn@poweryourpractice.com or follow her on Twitter @madelyn_young.
The material and information contained on this website is for general information purposes only. You should not solely rely upon the material or information on the website as a basis for making any business, legal, medical, or any other decisions. While we endeavor to keep all information up-to-date and correct, all information in this site is provided "as is," and CareCloud Corporation and MTBC Inc. make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability, or availability with respect to the information contained on the website for any purpose. Any reliance you place on such material is therefore strictly at your own risk.
