This article was featured in the November 2015 Issue of MD News Minnesota. Click the image to view as a PDF.
By the time you read this, ICD-10 will be a reality. Will it be as bad as the hype? For some of you, unfortunately, the answer might be yes. For those of you who have done a better job of preparing, it will be a huge annoyance at best. Use these strategies to help your medical practice protect revenue and focus on specific areas that have the greatest impacts on your bottom line.
What’s changed in the documentation process?
In the new system, ICD-10 diagnostic and procedural codes are more complex and represent a significant increase in the number of codes used by physicians to get paid by insurers. Now, there are approximately 70,000 codes, whereas the ICD-9 system used approximately 14,000. Hospital codes also increased from 4,000 to 72,000. With all the concern, complexity and considerable training involved, the fundamental documentation principles really haven’t changed — if you don’t document what was done during the patient encounter, you didn’t do it. So it’s up to the medical practice to protect its revenue by properly documenting for reimbursement.
What are these potential impacts to your practice?
Medical practice leaders are painfully aware that both operational and financial efficiency are critical when converting to ICD-10. Recent news and research suggests:
- A decreased rate of claim acceptance by payers: The most recent Centers for Medicare & Medicaid Services (CMS) testing showed that Medicare acceptance rate of ICD-10 claims is only 90 percent1 — significantly lower than normal acceptance rate of 95–98 percent.
- Fewer patient visits per day: It is estimated that physicians will require 74 additional minutes during each day to document and determine ICD-10 codes. This will result in an average of four fewer patient visits per day, per physician.2
- Reduced revenue: Experts estimate a 30 percent reduction in revenue for the first three to six months of implementation.3
- CMS has recently announced that, for the first 12 months after ICD-10 implementation, Medicare will not deny claims based solely on the specificity of the ICD-10 diagnosis code. While this is welcome news, it is important to remember that a valid ICD-10 code is still required, and this applies only to Medicare claims.4
Strategies to combat lost efficiency and missed revenue during ICD-10 implementation
So how can you avoid coding horror stories? By recognizing what’s required to identify the appropriate ICD-10 code. You can — and should — enlist the help of all your external service providers to help you protect your bottom line during implementation. Together, you can develop separate strategies to address potential implementation pitfalls and improve outcomes. Start in these areas:
- Determine the most critical codes that need to be mapped from ICD-9 to ICD-10 for your physicians and coders. An analysis of your most-used ICD-9 codes can help determine which codes should be accurately mapped for ICD-10.
- Prepare crosswalks for your overall practice by analyzing comparable information for each specialty or provider.
- Determine what information your current chart documentation may lack that will be necessary for properly supporting ICD-10 diagnosis codes. A detailed review of your providers’ charts can highlight areas providers should focus on to ensure their documentation is adequate for accurate ICD-10 diagnoses.
- Help ensure your employees, physicians, software and vendors are all on track. A readiness plan will help you monitor all areas of implementation to ensure responsibility is properly assigned and the timeline is sufficient for your practice. Your readiness plan organizes each stakeholder along timelines and keeps information flowing between these functions. In most cases, you will need to make adjustments based on your unique situation.
- Assess whether you have an adequate line of credit available to cover any unavoidable cash shortfall while working through the initial challenges of ICD-10.
Our advice is don’t go it alone. Your accounting professionals or other specialists can be a rich resource for your practice, as many have access to data, tools and the expertise to uncover areas for improved efficiency and help you protect revenue during the ICD-10 transition.
- Healthcare Informatics, July 6, 2015
- The ICD-10 Impact on Providers and Health Plans, March 18, 2009
- Medical Economics, July 13, 2015
- AMA Wire, July 6, 2015