October 1, 2015.
Why is this date extremely vital for your specialty-specific medical practice? One word: ICD-10-CM.
ICD-10-CM has to be fully implemented in your practice by this date – or else all of your insurance claims for clinical treatment after this deadline will be denied. Therefore, some major preparations are necessary to continue receiving insurance reimbursements for your medical services. To assist you in your ICD-10 journey, we would like to give you 6 tips on how to execute a smooth and successful transition with the least number of road bumps along the way.
Naturally, the earlier you and your personnel begin to actively get ready, the easier it will be to monitor your revenue cycle after October 1, 2015. Therefore, don’t procrastinate on ICD-10 until the last minute.
1. Create a budget with all ICD-10-related expenditures.
Integration of ICD-10-CM codes into your medical billing systems isn’t going to be a quick snap of the fingers. ICD-10-CM is defined as a diagnostic classification system of medical codes and will expand from 14,000 to 68,000 codes. Due to the significantly increased specificity of ICD-10-CM codes, representation of diagnoses for medical billing purposes is far more accurate and relevant to the patient’s health condition and treatment than ever before. However, healthcare professionals have to get sufficiently trained in how to use these ICD-10-CM codes, change their superbills, and update their EMR/EHR software, so all of this requires additional finances and other resources.
America’s Health Insurance Plans (the national trade association for the health insurance industry) predicts that the ICD-10 transition will potentially cost the nation between an estimated $3.2 billion and $8.3 billion. For a small to a medium-sized specialty practice, ICD-10 expenditures can range from an estimated $83,000 to $285,000, according to consulting firm Nachimson Advisors, LLC.
Nachimson advisors also goes on to estimate more specific costs associated with ICD-10:
Small practice (approx. two physicians and three staff):
- Education – $2,405
- Process analysis – $6,900
- Superbills – $2,985
- EMR/EHR software -- $7,500
- Increased documentation costs -- $44,000
- Temporary loss of revenue -- $19,500
Medium-sized practice (approx. 10 physicians, 1 coder, six staff)
- Education – $4,475
- Process analysis – $12,000
- Superbills – $9,950
- EMR/EHR software -- $15,000
- Increased documentation costs -- $178,500
- Temporary loss of revenue -- $65,000
However, the organizational systems of every specialty-specific practice vary to a greater or lesser extent, so take the above figures with a grain of salt. The bottom line is: the ICD-10 transition isn’t something you can fully incorporate in a few days or even weeks. It requires careful planning that most definitely includes a budget, so take a little time to find out how much implementation is going to cost you.
2. Start using ICD-9-CM codes as precisely as possible.
To become better accustomed to the degree of specificity required of ICD-10, find and utilize the most specific ICD-9 codes for the types of clinical treatments that you deliver, and get your administrative personnel on board as well. Strive to be highly detailed and accurate with your clinical documentation and ICD-9 coding so that the level of detail required in ICD-10 would be easier to acclimate to when you finally have to use it all the time.
Get other members of your medical team to do the same – in terms of being very exact with their clinical documentation and codes so that everyone is on the same page. This effort will enable everyone to progress through their ICD-10 training more smoothly and with minimal errors. As the practice owner, you wouldn’t have to shoulder the learning curve of ICD-10 on your own.
3. Become well-versed with ICD-10 through training before the deadline hits.
Despite the dramatic expansion of diagnostic codes from 14,000 to 68,000 in ICD-10-CM, you shouldn’t have to memorize it all. If you are a healthcare professional specializing in dermatology, ophthalmology, or even plastic surgery, then we suggest that you compile a list of your most common diagnoses and clinical services. Then find out which sets of ICD-10 codes best correspond with them. So, all you have to do is zero in on which ICD-10 codes you will be using the most and ensure that your clinical documentation matches the level of specificity and precision in those codes.
As an analogy, consider all of the words and their definitions in a comprehensive dictionary. You don’t need to know all of the words in the dictionary just as you don’t need to know all of the ICD-10-CM codes because most of them aren’t applicable to you.
That said, think of ICD-10-CM as a tool that enhances the relevancy and accuracy of your patient care in electronic medical records and claims. A highly accurate ICD-10 code (as opposed to a more ambiguous ICD-9 code) also plays a crucial role in the suitable reimbursement of your clinical efforts.
Train your associate physicians and medical billing staff on the same sets of ICD-10 codes pertaining to your practice. Online courses and other resources are available for personnel who like flexibility of online education. Others may prefer a more traditional class setting where students can ask questions, receive hands-on practice with ICD-10, and handle any issues with the help of an instructor and other students.
Stay tuned for Part II of the Six Steps to Take in the Preparation of ICD-10 where we will cover the last three components of a successful ICD-10 transition.
