Mitigating The Risks of ICD-10

Written by on April 4, 2012 in Practice tips - No comments
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By Amy Dunatov, MPH, FACMPE, CCS-P, Director, Coding Services Management Services On-Call, Inc.

The implementation of International Classification of Diseases, 10th Edition (ICD-10) will bring several challenges to hospitals, physician practices, health plans, vendors and many others. To meet these challenges, you must analyze how the transition is going to impact your business, assess the necessary changes, and plan for the financial impact.

To fairly assess how the transition will impact your business, key members of the organization must be brought together for a detailed look at operations. It is important to develop a strategy for implementation which includes a readiness assessment, an impact assessment, training plan and budget. Centers for Medicare & Medicaid Services (CMS) provides a very helpful guide for physician practices.

Business process changes to assign new codes at the most efficient point, staff training, communication among physicians, other providers, hospitals, and insurance carriers, and forms and systems updates are only a few of the ICD-10 transition challenges. The organization should develop a detailed assessment with thoughtful planning for the sequencing of events. Key critical components should be assigned to appropriate people within your organization. Assemble an implementation team and have regular meetings to foster effective communication and develop strategies to minimize problems and maximize opportunities.

Training of providers and staff can potentially be the most costly and time consuming component of the transition. Who should be trained? When should key people be trained? How do we assess and improve providers’ coding and documentation?  These questions are only a starting point for the assessment.

The financial impact of the ICD-10 implementation to the organization could be significant. Medical Group Management Association estimates ICD-10 conversion costs for a three-physician practice to be $83,000 with as many as four fewer patients a day being seen. A Health Leaders Media survey reports: 46 percent of health care leaders anticipate revenue loss from ICD-10 implementation. Careful planning will aid in keeping the cost at the lowest level possible. To financially plan for the transition, you should ask:

  • What is the cost to train the staff and physicians?
  • What is the cost to modify processes and forms?
  • What is the cost of the necessary software changes?
  • What if a significant number of claims are denied post 10/1/2013?

The answers will help the organization plan for potential expense increases without corresponding revenue.

Creative solutions to reducing the financial impact may include teaming up with other local providers for cost savings. You might be able to train a staff person from one practice, who can in turn train staff members in other practices or hire one onsite trainer for multiple practices.

The risks can be reduced if the organization plans for the changes in a methodical manner, communicates effectively with internal and external team members, and prepares for the financial impact through a careful risk assessment. Asking questions and staying informed are keys to implementation success. Visit the CMS website often for updates: https://www.cms.gov/ICD10

 

 

 

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