ICD-10-CM Fact Sheet Developed by Coalition
New ICD-10 study confirms CMS underestimates costs and time required to implement complex new code set
The American Academy of Dermatology, American Academy of Professional Coders, American Association of Neurological Surgeons, American Association of Orthopaedic Surgeons, American Clinical Laboratory Association, American College of Physicians, American Medical Association, American Optometric Association, American Physical Therapy Association, American Society of Anesthesiology, and the Medical Group Management Association retained Nachimson Advisors to assess the cost impact of the proposed ICD-10 rule on providers. Nachimson Advisors estimated the cost impact of an ICD-10 mandate on three different provider practices:
- A typical “small” practice, comprised of three physicians and two impacted administrative staff.
- A typical “medium” practice, comprised of 10 providers, one full-time coder, and six impacted administrative staff.
- A typical “large” practice, comprised of 100 providers, with 64 coding staff comprised of 10 full-time coders and 54 impacted medical records staff.
Total Cost Impact of ICD-10 Mandate on Individual Provider Practices
- For a typical small practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as $83,290.
- For a typical medium practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as $285,195
- For a typical large practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as more than $2.7 million.
Cost Impact of ICD-10 Mandate in Six Key Areas
Requiring five times as many codes as the previous code set, the proposed rule would impact every aspect of business operations for physician practices and clinical laboratories and produce significant added costs in six key areas:
- Staff Education & Training. Nachimson Advisors estimates the staff education and training costs associated with an ICD-10 mandate would range from $2,405 for a small practice to $46,280 for a large practice.
- Business-Process Analysis of Health Plan Contracts, Coverage Determinations & Documentation. Nachimson Advisors estimates the business-process analysis costs associated with an ICD-10 mandate would range from $6,900 for a small practice to $48,000 for a large practice.
- Changes to Superbills. Nachimson Advisors estimates the changes to new claim form software (superbills)costs associated with an ICD-10 mandate would range from $2,985 for a small practice to $99,500 for a large practice.
- IT System Changes. Nachimson Advisors estimates the IT costs associated with an ICD-10 mandate would range from $7,500 for a small practice to $100,000 for a large practice.
- Increased Documentation Costs. Nachimson Advisors estimates the increased documentation costs associated with an ICD-10 mandate would range from $44,000 for a small practice to $1.785 million for a large practice.
- Cash Flow Disruption. Nachimson Advisors estimates the cash-flow disruption costs associated with an ICD-10 mandate would range from $19,500 for a typical small practice to $650,000 for a typical large practice.
The American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical, and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin. For more information, please visit www.aad.org.
The American Academy of Professional Coders (AAPC) was founded in 1988 in an effort to elevate the standards of medical coding by providing certification, ongoing education, networking, and recognition. Currently, the AAPC has a membership base of 72,000 worldwide, of which more than 52,000 are certified. For more information please visit www.aapc.com.
The American Association of Neurological Surgeons (AANS) was founded in 1931 as the Harvey Cushing Society. The AANS is a scientific and educational association with over 7,400 members worldwide. It organization is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All Active members of the AANS are board certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada, or the Mexican Council of Neurological Surgery, A.C. For more information please visit www.aans.org.
The American Association of Orthopaedic Surgeons was founded by the Academy Board of Directors in 1997, the Association engages in health policy and advocacy activities on behalf of musculoskeletal patients and the profession of orthopaedic surgery. For more information please visit www.aaos.org.
The American Clinical Laboratory Association (ACLA) is a not-for-profit organization created in 1971 that offers members the benefits of representation, education, information and research. Its primary purpose is to advocate laws and regulations that recognize the essential role that laboratory services play in delivering cost-effective health care; encourage the highest standards of quality, service and ethical conduct among its members; and promote public awareness about the value of laboratory services in preventing illness, diagnosing disease, and monitoring medical treatment. For more information please visit www.acla.org.
The American College of Physicians is the largest medical specialty organization and the second largest physician group in the United States. ACP members include more than 125,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illnesses in adults. For more information please visit www.acponline.org.
The American Medical Association helps doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues. Working together, the AMA’s quarter of a million physician and medical student members are playing an active role in shaping the future of medicine. For more information on the AMA, please
The American Optometric Association represents approximately 36,000 doctors of optometry, optometry students and paraoptometric assistants and technicians. Optometrists serve patients in nearly 6,500 communities across the country, and in 3,500 of those communities are the only eye
doctors. Doctors of optometry provide two-thirds of all primary eye care in the United States.
For more information please visit www.aoa.org.
The American Physical Therapy Association (APTA) is a national professional organization representing more than 72,000 members. Its goal is to foster advancements in physical therapy practice, research, and education. The mission of APTA is to further the profession’s role in the prevention, diagnosis, and treatment of movement dysfunctions and the enhancement of the physical health and functional abilities of members of the public. For more information, please visit www.apta.org
The American Society of Anesthesiologists. Anesthesiologists: physicians providing the lifeline of modern medicine. Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 43,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient. For more information please visit www.asahq.org.
The Medical Group Management Association, founded in 1926, is the nation’s principal voice for medical group practice. MGMA’s more than 21,500 members manage and lead 13,500 organizations, in which more than 270,000 physicians practice. MGMA’s core purpose is to improve the effectiveness of medical group practices and the knowledge and skills of the individuals who manage and lead them. MGMA headquarters are in Englewood, Colo. For more information please visit www.mgma.com.
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