Are you Gambling with Your Bottom Line?

By Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CEMC, COBGC, CPCD, CCS-P

Is your organization delaying the implementation process.  Do you feel like the federal government will delay ICD-10 so you are procrastinating beginning the process? Are you risking delay and in some cases lost revenue in 2013?  ICD-10 seems like a long time away, but is it?

I can remember when we were told ICD-10 would be here in 2000 but was pushed back due to Y2K concerns. Everyone in the industry agrees the change will be difficult, but it is evident in reviewing the new code set that ICD-10 will have greater specificity, which is something those who actually use administrative data have been screaming about for years. The real headache will come to those brave individuals who must learn the new coding conventions and implore the physicians to document to that level of detail to support the ICD-10-CM diagnosis codes.

When speaking with health care organizations in the industry it is obvious that many are gambling on CMS and HHS delaying implementation of ICD-10.  The consensus is that every federal mandate has been delayed in the past, so why not just “wait and see.” This thinking might affect your bottom line.  CMS has been very clear that the ICD-10 implementation date of October 1, 2013, will not be delayed.  In fact, CMS has been working on implementation even prior to the final rule. We have only 48 months now to “get ready”. Procrastination or delaying the process will affect your bottom line.  The truth is if your organization is not ready to submit claims on October 1, 2013, your revenue and cash flow is at risk.  If the health plans are not ready to receive claims with ICD-10 codes, the practice or facility does not get paid.  The bottom line is that all providers, facilities, hospitals and health plans need to begin getting ready for ICD-10 today.

Implementation for ICD-10 will not simply entail “flipping a switch” but involves conducting an impact analysis looking at all system and organization processes and systems that currently use ICD-9-CM and will use ICD-10 in the future.  Implementation will take organization, analysis, education and training as well as budgeting for the cost and the impact of ICD-10.  The process will take several months to accomplish, and taking the approach of “burying your head in the sand” will only affect your organization in an adverse way. The amount of work that needs to be done to prepare for this is overwhelming.  Of course the coders and providers need to be trained on this new system. The software vendors, IT department, billing, insurance companies and other parties all must get on the bandwagon now.

The new electronic transaction set, known as the 5010, will be required for the electronic submission of ICD-10-based claims and the exchange of other administrative data between providers and payers. The 5010 set must be in place and fully tested before the ICD-10 transition can take place. The federal deadline for this changeover is January, 1, 2012. The process of the conversion to 5010 should be taking place in your organization right now.  The new transaction set and ICD-10 will require the modification of virtually all health information programs, including practice management systems and EMRs.  Everyone needs to start the process to get ready now and not wait until 2013 to prepare.

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One Response to “Are you Gambling with Your Bottom Line?”

  1. terry says:

    This is something Bill wants discussed at the MAD meeting. FYI

    SWR

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