Practices unresponsive to ICD-10 transition

Many practices unresponsive to ICD10 transition

Many in the provider community seem unresponsive to the ICD-10 transition planning message…especially the smaller private practice, whose staff is often under-resourced and over-committed.

The 2013 ICD-10 Survey Results, published by the Workgroup for Electronic Data Interchange, found that “over two-fifths (40 percent) of provider respondents indicated they did not know when they would complete their impact assessment, business changes and begin external testing. This is essentially the same [result] as [was seen] in the 2012 survey, and indicates that many providers have not made significant progress toward ICD-10 implementation. About a tenth of providers expect to begin external testing in 2013, while half responded that they did not know when testing would occur. In the 2012 survey, the number who did not know when external testing would occur was about the same…” 

Our client visits confirm these findings, as the common comment we hear from our practices is “Won’t the software handle this for me?” Well, not so much this time around.

While the technology pathway, connecting the practice to the final destination payer, will likely be in place by Oct. 1, 2014, what appears to be lagging is impact planning at the practice level.

Physician documentation is the first point of impact for this new code set. If the physician doesn’t capture the new level of detail required to support an ICD-10 claim in his patient visit notes, there is little that can be done down the line to get the claim coded correctly. Without proper supporting detail, the claim is likely to be rejected.

Let’s look at an example: Under ICD-9, code 729.5 covers “pain in the limb.” Under ICD-10, it explodes into 31 possible selections based on which limb and which side of the body. In ICD-9, there are 14,000 codes. In ICD-10-CM there are 69,000 codes. This explosion of “specificity” will have a profound impact on the physician’s practice.

What is your practice doing to prepare for the impact of ICD-10 on your workflow, on your technology providers and, most important, on your financial future? Each practice owner needs to ask a number of questions. Will each of these new codes pay the same as the old ICD-9 codes they replace? Do I need to analyze which codes represent the largest percentage of my revenue? Do I need to research how these codes translate into the ICD-10 world? (A hint: Some ICD-9 codes explode, some expand only slightly and some don’t change at all.) 

What if payers pay differently for certain ICD-10 codes as compared to the old ICD-9? How will this affect practice revenue? Does the practice need to talk to its top payers to understand what to expect in terms of revenue flow into the practice? Will the practice need to re-negotiate contracts with some or all of its payers?

Get started now. Don’t wait. Appoint a person in the office to head up your ICD-10 planning process. There are numerous educational resources currently available on the web. The Centers for Medicare & Medicaid Services site is chocked full of resource information. ADP AdvancedMD offers the site as a resource-gathering place that points you to multiple industry resources, webinars, whitepapers and for-fee training sessions. Begin your educational journey now. October 1, 2014 is closer than you think.

Colette Weston joined ADP AdvancedMD in 2003, serving in many roles within the organization, including director of Client Services, responsible for implementation and training, and as product manager, where she is currently responsible for the evolution of the core practice management product. Colette’s 23-year healthcare career has included managing a billing service serving over 200 physicians, managing a family practice clinic, and editing for a medical necessity review service. She is passionate about healthcare billing and customer service.

Mike Bearnson joined ADP AdvancedMD in April 2012 as a research analyst supporting the Practice Management product line. Prior to AdvancedMD, he had 15 years of experience as a business process improvement analyst and data design analyst working for various companies involved in consulting, product development and business intelligence. He earned his Six Sigma Black Belt certification while working for Affiliated Computer Services (Xerox ACS).