ICD-10: Don’t Let Your Practice Bury Its Head in the Sand
Published in Coding Edge – June 2010
Without proper ICD-10 implementation, revenue comes to a grinding halt.
By Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, COBGC, CPDC, CCS-P
We are seeing very little movement by physicians and physician’s groups in the industry regarding ICD-10-CM preparation. Health plans and government payers are working on their implementation plan and hospitals are beginning the process, but physician and physician groups of varying sizes continue to wait. It is somewhat understandable in many respects. With the current state of health care reform, it’s unknown how this will affect them. President Obama’s Stimulus Plan, which includes incentives for physicians to move to electronic health records (EHRs), makes ICD-10 seem like just another mind boggling and overwhelming task in health care.
One thing is for sure, the message from the U.S. Department of Health and Human Services (HHS) is clear. The final rule, published more than 16 months ago, and ICD-10 are a reality. Get moving and begin the implementation process, as there will be NO delay.
Reluctance Brings Financial Ruin
To put the impact of delaying into perspective, here is a scenario that can happen if the necessary steps aren’t taken to implement ICD-10:
It’s Dec. 1, 2013 and Sarah Reid’s practice has not received payment from any of her payers since ICD-10 implementation occurred on Oct. 1. Because Sarah’s medical group did not take the time to properly implement ICD-10, many payers now ask for documentation and every claim submitted is either suspended or denied. They relied on their vendor for software and did nothing else. The vendor mailed Sarah the software but never tested it end-to-end, so now many of the claims are bouncing all over the place.
An impact analysis wasn’t done and hardware wasn’t upgraded, so now Sarah’s practice management system is so slow it takes 10 minutes to pull up a patient in the system. The insurance carrier policies weren’t reviewed, and the staff wasn’t trained. For the past two months everyone has been guessing in regards to the codes. Ironically, every code the doctors’ select are unspecified codes. For claims the payers did receive, countless requests for documentation are piling up on Sarah’s desk. Why? The use of the unspecified codes triggered a pattern of misuse and overutilization, which is one of the reasons for migration to ICD-10—detail and specificity. The entire office is a mess. The practice is now financially strapped and the physicians have told the staff they might have to close.
Don’t let this to happen to your practice. Without payment from your payers, the financial health of your practice is at risk. How long will you or your medical practice survive without revenue?
Have a Firm Process in Place
I can’t reiterate this enough: ICD-10 implementation is not just a software update or a software fix. Systems and processes need to be in place and functional. This will take a few years to accomplish, and YES this will be expensive, which we must budget for carefully. Otherwise, your practice just might end up like Sarah’s—financially devastated and a real mess!
Help is Here
AAPC has developed a couple of really valuable ICD-10 tools available at www.aapc.com/ICD-10/, which are at no cost, and very few people are using them:
- Benchmark Tracker, as shown in Figure A, is a guide to help you with implementation. It lists the steps necessary for implementation based on your practice size and/or health plan.
- ICD-10 Code Translator, as shown in Figure B, is a simple electronic version of the General Equivalency Mapping (GEM) files from the Centers for Medicare & Medicaid Services (CMS). You can enter an ICD-9-CM code and it will list all the possible ICD-10-CM codes. You also can enter an ICD-10-CM code and it will map backwards to ICD-9-CM. This is helpful for implementation, especially if you continue to use a superbill to see code choices in ICD-10. Payers can use these files to map their systems and policies, as well.
These tools were developed to assist AAPC members and their providers with successful implementation.
Educate Now for the Future
Attend an ICD-10 Implementation Bootcamp, offered by AAPC. The first day of the boot camp focuses on coding to help you get the documentation in your office up to speed and the second day focuses on implementation.
Take the ICD-10 Implementation distance learning course and webinar. Distance learning does the same as bootcamp, only in the comforts of your personal computer. Either method is a good first start in getting your practice ready for the future.
Don’t let what happened to Sarah’s practice happen to you. Get up from your desk and have a good heart-to-heart with your doctors now, and bring ammunition with you when you go. Don’t forget to show them the final rule, articles on ICD-10, and share with them what the impact could be if they decide to bury their heads in the sand. So get going!