MD Billing Expert

In his 1743 publication “Advice to a Young Tradesman” Benjamin Franklin said “Remember time is money.” That statement is just as true today as it was in 1743, maybe more so. Now, fast forward to 2013 and time is still money and if you are in the healthcare industry time is passing quickly! On October 1, 2014 the ICD-9 diagnosis and procedure codes must convert to ICD-10. Exactly what is ICD-10? The ICD-10 is a complete replacement code set designed to provide greater detail for diagnoses’ and impatient hospital procedures. If you’ve wasted time in by not preparing for ICD-10 you have in fact been wasting money also.

Because the current ICD-9 codes are entwined throughout clinical and financial operations and systems the implementation of ICD-10 is sure to be difficult, time consuming and costly. Switching to ICD-10 will require additional technology purchases and time for administrative training. Many who have been bracing for the conversion and have already budgeted for the initial costs can still be hurt if they are unaware of the potential consequences should they fail to convert as expected. Here are four obstacles you must overcome to achieve a successful conversion:

Training & Retraining – Most organizations realize their support staff will be required to undertake additional training. It’s essential for administrators to understand that their biller’s will be required to learn how to utilize roughly 150,000 codes as opposed to the 18,000 associated with ICD-9. This additional training could take from 50 to 100 hours for each biller.

It’s a good bet that many haven’t anticipated the need to train another essential person – the physician. Most physicians will need to change their documentation routine if they expect to be in compliance with the modified coding procedures. All aspects of a patients visit will need to be noted to avoid an improperly coded encounter which could result in a claim denial. For example, a patient is complaining about pain in a limb. Physicians will be required to specify which limb and whether it’s on the left or the right. If he codes pain in the limb without specification he will be leaving money on the table. By not learning the essentials of the new code sets physicians could leave out specifics which will result in lower reimbursements.

Decreased Productivity – In the short-term, the training period required for the ICD-10 transition will allow physicians and staff less time to dedicate to their normal duties. In the long term, patient visits may take longer due to the increased detail of the code standards. Also, submission delays are likely because coders will need to ask questions of physicians in order to verify information. If they neglect to question the information and exclude necessary details claim denials will increase. Physicians and practice managers need to prepare for decreased productivity and the financial impact that will result.

Processing Overlap – It’s required that all claims go out in ICD-10 beginning October 1, 2014. This is mandated by the date of service and not the date of transmission. This means any claim with a service date prior to October 1st will have to go out in ICD-10 format. This means if billers are behind they will be required to submit claims in both formats until they get caught up. As a result older claims could be in play for months after October 1st causing claims to be rejected, denied and appended.

Stalled Cash Flow – Fallout from the ICD-10 conversion will have an effect on the entire healthcare community likely causing a slowing in cash inflow. During the adjustment period there could be an increase in claim errors and delays.

When combined, the effects of the ICD-10 consequences listed in this article could effectively pause your financial operations or at the very least slow them down significantly. The future outcome of the ICD-10 conversion is impossible to predict today but it’s likely the repercussions will be far-reaching for medical practices.

If you are a client of Synergy Billing you needn’t worry. We will be providing a series of web and onsite trainings to make sure you and your staff are prepared. Not to mention, with us managing your revenue cycle “you’re in good hands.”