Don’t leave ICD-10 to the coders: Five tips for minimizing the risk to your practice

May 27, 2011

Don?t leave ICD-10 to the coders: Five tips for minimizing the risk to your practice

If you think converting to ICD-10 is just a coding issue, you’re in for a surprise.

ICD-10 conversion will cost a small practice with three physicians more than $83,000, while the cost for a 10-physician practice will be about $285,000, according to a report from Nachimson Advisors LLC, “The Impact of Implementing ICD-10 on Physician Practices and Clinical Laboratories.”

 “The conversion will affect every aspect of a practice from patient access to revenue and analytics,” says Deena Marlow, a management consultant at Ingenix. “It is a monumental project that will lay the foundation for transformative initiatives over the next 5 years.”

“It’s almost a bet-your-practice proposition,” says Jimenez Consulting’s Cheryl Clancy of the requirement to use ICD-10 codes for every HIPAA-covered transaction by October 1, 2013.

The U.S. Department of Health and Human estimates that “the percent of returned claims may peak at around 6% to 10% of the pre-implementation levels” for the first 3 to 6 months post-implementation, and that practices will experience elevated claims-processing costs for the first 3 years of the implementation. Given that many practices operate on  relatively thin margins, that’s a big cost to absorb.

To help practices minimize the impact of implementing ICD-10 on revenues, Marlow shared five tips with Medical Economics:

•Define your baseline. Practices need to know how their reports are created, what reports are produced, and how they are used so they can be replaced in the ICD-10 format.

•Know where your partners-payers and vendors, particularly-are in the process. “At least 80% will use ICD-10 codes,” says Marlow, so it’s important to know when they expect to be ready to make the switch. “You may need to push them to meet your timelines” to keep rework to a minimum, she adds.

•Understand that this is practice-critical, not an IT or coding issue. “This conversion will affect operations, IT, finances, and reimbursement. There is no way to make it work without support at the top. If the IT group just runs with it, it will be hard to get others on board” unless they understand the importance to the entire practice, says Marlow.

•Decide how you are going to approach the conversion. “Are you looking just for compliance or for optimization? In other words, do you want to just get it done or get it done right?” asks Marlow.

•Take advantage of the opportunity to accomplish other goals during the conversion. “If you are planning a clinical documentation improvement program, you can get physicians used to new ways of documenting that will acclimate them to some of the changes needed for ICD-10.”

“The only way to mitigate the impact on resources and finances is with planning,” says Marlow. “Everyone will see, use, or document with the new codes, and they’ll all need different kinds of training, so start early to give people the opportunity to adjust. Then, audit proactively and test thoroughly to minimize reimbursement risks.”