|Articles|May 19, 2015

The ICD-10 transition: Avoiding revenue disruptions

Physicians can take steps, ranging from documentation training to taking out a line of credit, to keep their practice financially healthy during the transition to ICD-10

Scheduled to be fully implemented on October 1, 2015, ICD-10 includes about 80,000 diagnostic codes, compared with the 14,000 in ICD-9, which has been in widespread use since the 1970s. The new system requires much more specificity while documenting patient visits for both public and commercial third-party payers to consider claims and to deny or revise payments.

In early March, the American Medical Association (AMA) and 99 state and specialty societies voiced concerns regarding ICD-10 to the Centers for Medicare and Medicaid Services (CMS). The groups fear that inadequate contingency measures for the ICD-10 transition could lead to a multi-billion dollar disruption for physicians while posing serious access to care issues for Medicare patients.

End-to-end testing revealed that the claims acceptance rate would have declined from 97% to 81% if ICD-10 had been implemented then. A decrease of that magnitude could result in an alarming backlog of unpaid Medicare claims.

Related:ICD-10 documentation: The key to getting paid

“Robust contingency plans must be ready on day one of the ICD-10 switchover to save precious healthcare dollars and reduce unnecessary administrative tasks that take valuable time and resources away from patient care,” AMA President Robert M. Wah said in a written statement.

Although CMS offers general equivalent mapping code translation to convert from ICD-9 to ICD-10 (or vice versa,) the system is often cumbersome to interpret. In some cases, the conversion results in convoluted and inconsistent mappings, says Andrew Boyd, MD, assistant professor of biomedical and health information science at the University of Illinois at Chicago.

“The first step in preparing for ICD-10 is to learn the new ICD-10 codes that will directly apply to physician practices,” says Boyd, whose team of researchers developed a website that guides healthcare providers through the transition. “What are the rules around the new codes?” For example, under the new system physicians will have to specify whether an ear infection is present in the right or left ear or both ears. 

 

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