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Healthcare providers ready for ICD-10, say delay is too costly

Many have hired coders to avoid lost reimbursements from not making the switch.

Susan Morse, Senior Editor

Healthcare providers say they are ready to implement ICD-10 diagnostic and billing coding on Oct. 1, because they can’t afford not to be.

Despite the threat of another Congressional delay, health information management professionals are already testing ICD-10 to avoid costly consequences of missing the deadline.

“They can’t take any shortcuts,” said Torrey Barnhouse, co-founder and president of consultant Trust HCS. “Even in mundane cases, a small error in documentation can have an extremely large impact on an organization; create a problem from a revenue standpoint.”

ICD-10 is expected to increase the number of billing codes from 13,000 to an estimated 68,000. - Tweet this

If an audit doesn’t support a particular diagnosis coding, the payer could get a recoupment, he said.

“If you don’t document infusion, it’s an injection, it’s an injection at a lower reimburse rate,” he said. “ICD-10 is impregnated with thousands of documentation concerns.”

Some organizations are being told to increase their cash reserves in anticipation of delayed payment and denials, Barnhouse said.

“That’s at the heart of CFOs top 10 challenges,” he said. “Are they concerned? Absolutely.”

The Oct. 1 deadline comes after Congress last year inserted language into the Protecting Access to Medicare Act of 2014 that pushed back implementation. ICD-10 was delayed at least twice before that.

“There’s a 50/50 split between those who believe it is going to happen this year and those who don’t,” said Mary Beth Haugen, president and CEO of consulting firm HCG Group.

It’s physicians who need the push, however.

“Where we’re seeing difficulty in getting total engagement is more with the physician,” said Haugen, a former HIM director at Denver Health. “I think they feel it’s not going to happen.”

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At least one doctor has decided not to deal with it.

“One physician is planning on it so much he’s retiring the day before,” said Cheris Craig, Chief, administrative officer for Urology of Greater Atlanta. “We’re trying to make it as easy for them as possible.”

The revenue cycle and medical billing processes begins with physician coding, and ICD-10 is expected to increase the number of billing codes from a current 13,000 to an estimated 68,000.

The American Medical Association has called ICD-10 a “massive, unfunded mandate” for physicians already overwhelmed by regulatory requirements.

The complexity of the new system has some providers farming out the coding process, or hiring consultants and more coders.

Nearly half of the 650 hospitals in a recent survey said they would outsource ICD-10 services when the new diagnostic and coding system goes online, according to market research firm Black Book Rankings. The Black Book survey found that 19 percent of hospitals are outsourcing coding already, but that the number is anticipated to grow to 47 percent of hospitals.

That solution can be risky and costly, according to Barnhouse.

[Also: Social media momentum continues around ICD-10 deadline]

“When choosing to outsource some or all of your coding you must be careful to manage your risk and your budget," Barnhouse said.  "It's essential that the quality of the coding be monitored by both organizations and budgets managed through constant communication.” 

When ICD-10 goes live, he said, the data suggests coding will take at least 40 percent longer than it does now using ICD-9.

“It requires education, a change in policy in procedures, it requires a great deal of training, it requires end-to-end testing. It takes away time from when coders sit and code,” Barnhouse said. “You cannot implement ICD-10 in your environment without adding some resources. Period.”

Haugen, who provides training and testing to hospitals, is not seeing much outsourcing, she said.  She’s seeing hospitals and physician practices having to maintain two systems until Oct. 1, and perhaps beyond. “From a cost perspective it is difficult for clients,” she said.

However, practices would be putting money into upgrades anyway.

“The cost is around testing and training,” she said. “As physicians are looking at documentation improvement that needs to happen regardless of ICD-10.”

Those who will be ready on Oct. 1 have taken the year to beef up training and practice time, she said.

“I think there are a lot of organizations, with (the previous) delay, that might not be prepared,” she said. “There are going to be organizations very ready and others caught off guard. With every delay it costs the industry so much money.”

But Barnhouse said the majority are prepared. “We’ve finally got the CMS behind it, finally got the payers behind it. The tide has turned, we’ve got a huge wave of preparedness that has occurred. People have a vested interest in the success of ICD-10.”

A recent Government Accountability Office said the Centers for Medicare and Medicaid is indeed prepared. Medicare scheduled end-to-end testing with 2,550 covered entities in January, and is planning on testing again in April and July. 

[Also: GOA says CMS is ready for ICD-10]

The Medicare testing went better than Medicare had hoped, according to Haugen, and that’s a blessing since another delay would be more trouble than help.

“After what happened at the end of the year last year,” she said, “never again.”

Twitter: @SusanMorseHFN

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