The Coming ICD-10 Cash Flow Crisis and How to Avoid It

ICD-10 is the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). ICD is a diagnosis classification system whose initial version goes back to the Black Plague, when European governments and medical professionals were trying to compare causes of death with those of other nearby countries in order to understand and combat reoccurring disease.

Today, the World Health Organization maintains this comparative information, and since the United States is the only country still using ICD-9, the move to ICD-10 will enable more accurate comparisons of healthcare data with other countries. But the most important part of this change for your practice is that federal regulations will require more and better data tracking to measure the quality and safety of care—something enabled by ICD-10. There are a number of benefits to this transition, says Charles D. Krespan, M.D. of the Drs. May Grant Associates practice.

According to Krespan, “ICD-10 gives us more data about our patients’ medical conditions and the hospitals’ inpatient procedures. Better data leads to better decisions, which leads to better patient care.”

Many prudent hospitals and practices are already preparing for the shift to ICD-10, but most will still make the transition with significant effort and cost.

Frank Musso of Francis C. Musso, CPA, MPA, P.C., believes the transition will be substantial. “Not only does the new code set include five times as many codes as the ICD-9 code set,” he says, “but the different arrangement of codes will require more documentation, revised forms, retraining of staff and physicians, and changes to software and other information technology. I would also expect changes in reimbursement patterns …. “

“We are very concerned about the ICD-10 transition,” echoes Mona Engle, RN, CEO/Practice Administrator of Drs. May Grant Associates says. Even though she feels confident about the progressiveness and preparedness of her practice, she says “I know that ICD-10 will be very costly in terms of training our staff, implementing the codes and retraining our physicians. It is extremely important that we do it right, because if we don’t it will impact our patients—and that’s something we never want to happen.”

There are only 16 months leading up to the October 1, 2014 deadline. All HIPPA-covered entities must make the change to the new system, or will not be reimbursed by any payer—commercial, Medicare or MA. This would put a severe cramp in your practice cash flow, but can be avoided as long as your practice takes the correct steps to implement ICD-10.

Important note: If making diagnoses prior to October 1, 2014 to be billed or completed (surgical, testing, medication) after October 1, 2014, your deadline for ICD-10 transition is the first time you make that diagnosis. If not, you run the risk of losing the reimbursement or doing all of the medical coding and charting twice for those patient encounters.

Stay tuned for Part II of this ICD-10 series coming next week!