5 ICD-10 Questions to Ask Your PT Software Vendor

May 18th, 2015

Having the right EMR in place can help ease your practice’s transition to ICD-10—emphasis on the “right.” So, if you already use EMR in your clinic, it’s crucial that you make certain your vendor is ready for ICD-10. With the October 1 implementation date fast approaching, it’s about time you find out if your system is truly prepared to handle the transition. Shopping for a new system? Then ICD-10 readiness should be at the top of your buying checklist. To find out whether your current or future EMR is equipped to handle the switch, ask each vendor these five questions:

1. Is your system compatible with the new code set?

Ideally, your EMR software should be ICD-10 compatible long before October 1, 2015. That way, you’ll have a chance to test the new codes using fictitious patients before full implementation. If your EMR isn’t ready yet, you’ll need to find out exactly when the software will be ready so you and your team can conduct internal testing.

2. Will both ICD-9 and ICD-10 codes be available after the October 1 date?

Even after ICD-10 implementation, non-HIPAA-covered entities (think auto and workers’ compensation claims) might still require ICD-9 codes. To avoid claim denials due to incorrect submissions, you’ll want to be sure that your system can handle both code sets.

3. Will ICD-10 require a system update? If so, how much will it cost?

Some EMRs may require a costly update to switch to the new code set. If this is the case with your vendor, then I recommend investigating a new system. ICD-10 adoption is mandatory, so your software vendor needs to change no matter what; otherwise, it’ll go out of business. In my book, your practice shouldn’t have to foot the bill for a healthcare change that your vendor has to make. Furthermore, any system that requires excessive downtime or an expensive upgrade is most likely outdated, which means it probably won’t handle the switch so well. That could leave you saddled with unusable or glitchy tools or inaccurate claims. And what if it can’t handle the switch at all? In that case, you won’t have access to your documentation, patient records, schedule, or even your billing until your vendor gets with the program.

4. How will the system help with transitioning from ICD-9 to ICD-10?

Do you know how to code using the new ICD-10 code set? Are you positive you can find the most applicable ICD-10 code for each of your “go-to” ICD-9 codes—all without batting an eyelash? I’m going to take a wild guess that you aren’t quite to that point—yet. That’s why you need a system in place that will help you find the most complete and accurate code. Your system should make it easy for you to select the right code. However, it should never—ever—spit out one-to-one crosswalk conversions. That’s because a direct, all-encompassing ICD-9 to ICD-10 conversion simply doesn’t exist. According to this HIMSS article: “Although the implementation or use of an EMR can help with the documentation challenges providers will be confronted with in the new ICD-10 world, the use of an EMR alone is not a magic bullet.” So, if your current vendor offers a magic bullet, be wary. No software can produce a perfect one-to-one crosswalk without you, the practitioner, playing a vital role in the decision-making process. Thus, I recommend choosing an EMR that empowers you to select the most specific and correct code through the use of an intelligent and integrated tool.

5. Will you offer ICD-10 support? If so, how much will it cost?

Ideally, your system will offer ICD-10 support through educational resources and by having staff members available to answer phone calls and emails. A system invested in your success will offer all of this—for free. If you’re concerned about ICD-10’s complexity and how it will affect your staff’s productivity, be sure to find out how your system’s support team will help ease the transitional burden.

If you haven’t already, it’s time to start asking your vendors the right questions to find out how they will assist you during this time of change. And if you come to find that they aren’t prepared for ICD-10, then it’s time to shop for an EMR that is.

ICD-11: WHO’s With Me

May 11th, 2015

As the United States prepares for the transition to ICD-10 on October 1, 2015, the rest of the world—most of which boarded the ICD-10 coding train long ago—is turning its focus to ICD-11. With implementation set for 2017, the World Health Organization (WHO) is hard at work refining and improving the International Classification of Diseases (ICD) coding set “to better reflect progress in health sciences and medical practice.”

So, what does that all that mean? Here’s the deal.

What to Expect

The latest ICD update will be:

  • Available in multiple languages.
  • Defined in a structured way, so medical professionals can more accurately record definitions, signs and symptoms, and other disease-related content.
  • Compatible with electronic health applications and information systems.
  • Free to download online for personal use (and available in print form for a fee).

Get Involved

Want to take part in the revision process? You’re in luck. To “increase consistency, comparability and utility of the classification,” the WHO has invited experts and stakeholders—including researchers, health information managers, and healthcare providers—to participate in the review. You can become an appointed reviewer, or you can create an account on the ICD-11 online platform, which will allow you to:

  • Comment on classification structure, content, and implementation
  • Propose changes to ICD categories or disease definitions
  • Participate in field testing
  • Contribute to language translations

Keep in mind that all feedback will be peer-reviewed for accuracy and relevance by experts from the WHO’s two advisory bodies: Revision Steering Groups and Topic Advisory Groups.

While the US might not be ready for ICD-11—I mean, we’re still bracing for ol’ 10—it’s in our best interest to participate in—and keep one eye on—the revision process. It’ll undoubtedly help us when it comes time to transition again.

Third-Party Payers and Billers Fall Behind in the ICD-10 Prep Game

May 5th, 2015
ICD-10, Preparation

Moving a claim from submission to payment is a little like moving a football down the field and into the endzone. As every NFL fan knows, scoring a touchdown (i.e., getting paid) requires flawless execution at multiple touchpoints. And if one person drops the ball, your chances of putting points on the board (i.e., money in the bank) could be in serious jeopardy—and I’m not talking about America’s most beloved nightly quiz show.

That’s why, with less than half a year to go before the transition to ICD-10, many members of the healthcare community are concerned not about the initial ball-handlers—like providers and coders—but about the claim recipients and processors. Because as every insurance payment fan knows, the claim game is a lose-lose if billing vendors and third-party payers don’t perform on their end of the play. To circle back to the football analogy: Even the best quarterback in the world can’t throw a touchdown pass without a capable receiver to catch it.

Similarly, no amount of training and testing on the provider end can overcome a lack of ICD-10 prep work on the billing service and payer end, and according to reports cited in this Hospitals & Health Networks article and this Modern Healthcare article, payers and billers still have some work to do in the lead-up to the ICD-10 kickoff. “CMS has reported an 81 percent success rate in tests of incoming claims,” the Hospitals & Health Networks article states. But while a pass completion rate of 80-plus percent would be outstanding on the football field, it’s not so comforting to those who depend on timely claim reimbursement to maintain consistent cash flow. As the article goes on to point out, “…the American Medical Association has led an organized physician outcry declaring that a 19 percent failure rate would be ruinous to many practices.”

Of course, like many statistics, that percentage is a little misleading—a lot misleading, actually. In the Hospitals & Health Networks article, Sue Bowman, the senior director of coding policy and compliance for the American Health Information Management Association, pointed out that “…only 3 percent of the rejected claims…had to do with ICD-10 problems.” The rest of the rejections stemmed from issues with provider identification, service location validity, and other errors that have nothing to do with diagnostic coding. Furthermore, Bowman noted that in general, private payers have been proactive with their testing efforts—and in many cases, they’ve had even more testing success than Medicare has reported.

Still, Michelle Durner, president of Applied Medical Systems of Durham, North Carolina, worries that smaller payers won’t be ready to roll by the October 1 deadline. “The larger payers, Medicare and Blue Cross Blue Shield, they’ll be there,” Durner told Modern Healthcare. “With some of the state Medicaid agencies, I’m maybe not quite as confident. And with the smaller payers, I just don’t know. You just cross your fingers and hope. Just like with 5010, I don’t think it will come off without a hitch.”

Billers aren’t quite on top of their testing game, either—at least not based on the survey results published in the Modern Healthcare article. “…a majority of billers surveyed (57%) have not conducted basic, ‘internal testing’ of the ICD-10 handling capabilities of their systems,” the article states. Even worse: “Just 16% have conducted gold standard, external ‘end-to-end’ testing—in which a claim is sent, approved or rejected, and an explanation of what happened, called an electronic remittance advice, is returned.”

So, what’s stopping billers from gaining yards on the testing front? Well, according to the above-cited survey, top barriers include outdated technology (i.e., the need for software upgrades), problems with provider-submitted documentation, and uncertainty over the possibility of another ICD-10 implementation delay.

And while ICD-10 resistors could still throw out a hail-mary attempt at another implementation delay, their chances of success are, by most estimations, slim to none. What does that mean for PTs who depend on billers and third-party payers to maintain consistent cash flow? Well, you can only do so much to whip your vendors and partners into shape; at the end of the day, you’ve got to have your own back. So, if you haven’t already done so, start saving cash reserves now—or look into alternative ways of securing a financial cushion before ICD-10 go-time.

ICD-10 Delay Still Possible? All Signs Point to Definitely Not, Maybe

April 29th, 2015
ICD-10, ICD-10 Delay

The tumultuous road to ICD-10 has been fraught with anxiety, dissenting voices, and delays. Furthermore, uncertainty over the possibility of further setbacks has led many providers and vendors to fall behind in preparedness. However, as you may already know, ICD-10 didn’t make it into the newly passed SRG bill (a.k.a. HR2). And that’s a positive step forward from last year’s SGR legislation, which ultimately delayed implementation until October 1, 2015. But does that mean we’re really free and clear of yet another delay? Eh—sort of.

Even though this year’s legislation didn’t mention ICD-10, it could have. If Rep. Gary Palmer (R-AL) had been successful, HR2 would have included an amendment postponing the ICD-10 transition until October 1, 2017. Thankfully, that proposal didn’t make the cut, but the fact that it was part of the conversation at all is a bit worrisome. Plus, there are still folks out there—like Sen. Rand Paul (R-KY), Sen. John Barasso (R-WY), Sen. John Boozman (R-AR), and Rep. Ted Poe (R-TX)—who could attempt to resurrect dead amendments or push brand new legislation through to enactment as quickly as last year’s Protecting Access to Medicare Act.

The good news is that folks seem to be on board the ICD-10 train in much greater numbers than last year—and the dissenters have been far less vocal with their concerns. And ultimately, the government has made zero effort to further push back the deadline for the switch to ICD-10, and officials seem confident that CMS is ready for the transition. Members of the House Energy and Commerce Committee’s Subcommittee on Health have even declared their support for maintaining the current deadline.

While another delay is unlikely, no one can predict the future. Still, one thing remains certain: practices must be prepared. Stick to your ICD-10 preparations schedule, and keep an eye out for updates. If things change, we’ll let you know.

The Survey Results Are In (And I Don’t Think You’re WEDI for This Jelly)

April 22nd, 2015

We’re flying toward the ICD-10 implementation on October 1, 2015, but uncertainty regarding future delays—not to mention budgetary, staffing, and technological challenges—have caused vendors and providers to pull up on their ICD-10 preparations. According to the most recent Workgroup for Electronic Data Interchange (WEDI) survey, vendors haven’t made any progress in their preparations in the time since they participated in previous surveys. And providers? They’re actually falling behind in ICD-10 readiness.

Shockingly, a full two-thirds of the 796 providers surveyed have slowed or stopped preparation efforts, and only about 33% of providers have completed their ICD-10 risk assessments. To make matters worse, more than 25% of providers indicated that they didn’t plan to test externally until the second or third quarter of this year, and only 25% have tested with Medicare at all.

The grass on the vendor side isn’t much greener. Of the 173 vendors surveyed, only 60% are currently testing or ready for ICD-10—down 7% compared to the results of WEDI’s August 2014 survey. And just like the providers WEDI surveyed this year, 25% of vendors said they won’t be ready until the second or third quarter of 2015.

Like Robin Williams shouting, “Good morning, Vietnam!”, the results of this WEDI survey are a brash wake-up call. The switch to ICD-10 is coming, and even if it does happen to be delayed yet again, there’s no sense in delaying your preparations on the off-chance we get an extension. Take advantage of the six months we have left before the deadline, and make sure you’re as prepared as possible. Need help getting there? Check out these handy resources.

Nix the X: Why You Should Approach ICD-10 Crosswalks with Extreme Caution

April 20th, 2015

Looking for an ICD-10 easy button? Well, join the club—because it seems like every way you turn, healthcare professionals are clamoring for an automatic, out-of-the-box solution to the ICD-9-to-ICD-10 translation problem. And plenty of entities have stepped up to satisfy that demand. The problem is, most of their offerings—including automated software systems and plug-and-chug conversion tools like general equivalence mappings (GEMs)—produce less-than-satisfactory results. In fact, relying on those solutions alone could leave you not just unsatisfied, but completely blindsided by the transition to ICD-10. And with ICD-Day—October 1, 2015, that is—rapidly approaching, you can’t afford to waste another second searching for a silver bullet that doesn’t exist.

“But, wait!” you protest. “It does exist! I have seen it with my own eyes!” Well, if you’re referring to the solutions I mentioned above—and I’m assuming you are—then I’m sorry to be the one to disillusion you, but that’s exactly what they are: illusions. And here’s why you shouldn’t be fooled into believing they’ll be your sole saving grace:

1. GEMs cannot reliably produce one-to-one code translations.

As this EHR Intelligence article explains, GEMs were never intended to serve as single-code translation dictionaries. Because of the way they’re structured—in clusters of two to four related codes—GEMs may map one ICD-9 code to several ICD-10 codes and vice-versa. In other words, the majority of the time, GEMs won’t generate a single ICD-10 match for a single ICD-9 code, because “they are an incomplete method of translation,” EHR Intelligence reports. This ICDLogic whitepaper echoes that sentiment: “…the two systems differ so widely that all attempts at translation offer only a series of compromises and subjective choices. This is necessarily so because there is no ‘mirror image’ of one code set in the other.”

So, why do GEMs exist in the first place? EHR Intelligence has an answer for that, too: “GEMs can be used by anyone with a need to convert large batches of data, which will include payers, providers, researchers and informatics professionals, coders, vendors, and anyone with historical ICD-9 data that needs to be usable in the future.” Tasks that are well-suited to the use of GEMs include:

  • Generating converted data sets for large databases of ICD-9 codes.
  • Aligning data sets for long-term clinical studies that span the transition to ICD-10.
  • Analyzing data collected before and after the transition.
  • Creating reimbursement mappings to ensure claims containing ICD-10 codes will be paid following the transition.

2. There are no regulations or industry standards governing the creation and use of GEMs.

Although most people associate GEMs with CMS—and thus, assume they’ve been through some type of government quality control review process—the truth is that there are “numerous variations of the ‘national’ GEMs available from a variety of both public and private sources,” ICDLogic explains.

Furthermore, despite numerous efforts—dating all the way back to 2007—to establish national mapping standards for all GEMs, “No industry-wide standards that we are aware of were achieved and today there are many GEMs available from a variety of sources, EHR vendors and payers,” ICDLogic states. “No one really knows whether they are consistent or what the individual organizing principles and assumptions are that each developer used.” Essentially, putting all of your eggs in the GEMs basket would be like eating at a restaurant that doesn’t have to follow any health and safety codes—and that’s a gamble you definitely don’t want to take.

3. There is no automated tool or software that can generate accurate ICD-9-to-ICD-10 conversions 100% of the time.

I get it; it’s 2015, and there’s an automated alternative for pretty much every task. Heck, Google has even created a self-driving car. But when it comes to translating ICD-9 codes into the language of ICD-10, there’s no technology sophisticated enough to do the thinking for you. In fact, as ICDLogic points out, the new code set wouldn’t function the way it’s supposed to without the human decision-making factor: “GEMs are not finite crosswalks because they contain numerous instances of mappings where human intervention and judgment—based on analysis of the clinical documentation—is required to complete many of the links.”

And because most software vendors used GEMs to develop their ICD-10 conversion tools, the same cautionary advice applies to their use as well. Bottom line: while GEMs and code conversion programs can streamline the code selection process by narrowing down your options, you’ll still need to enlist your clinical expertise and critical thinking power to get all the way to the finish line. Here are the code translation steps we recommend following to determine an accurate match:

  1. Run your ICD-9 code through a conversion tool—like this one—and use the ICD-10 output as your starting point.
  2. Look up that ICD-10 code in the Tabular List.
  3. See if there are any variations of the code that offer a higher level of specificity.
  4. Check the associated category and chapter headings for additional coding instructions.
  5. If you can, code for the patient’s actual condition (e.g., patellar tendinitis) rather than merely the result of that condition (e.g., knee pain).
  6. If applicable, list the relevant external cause codes. You can find these codes—which further describe the circumstances of the injury or condition—in chapter 20 of the Tabular List.

All that being said, if you want to use a software to help you streamline your ICD-10 coding process, look for one that uses detailed, defensible electronic documentation as the foundation for code selection—and then empowers you to make the final call on the best code for the job. In other words, your software should get you halfway across the street, but it’s up to you to get all the way to the other side.

Fiscal Therapy: How to Develop an ICD-10 Budget

March 31st, 2015
ICD-10, Preparation

At this point, you should be ankle-deep in ICD-10 preparations, which means you’ve probably spent a whole lot of time staring at your clinic’s finances and trying to figure out how the heck you’re going to cover the cost of switching. (And if you haven’t started prepping, here’s how to get started.) I’d love to provide you with a one-size-fits-all budget, but that’s just not possible. Every clinic’s ICD-10 transition will be just a bit different from the rest based on its specific needs and characteristics.

As a general rule of thumb, your ICD-10 prep budget needs to account for all the factors that will cost you time, money, or both (time is money, after all). These include:

  • Technology upgrades or new software and/or hardware
  • Staff training on coding and new technology
  • Productivity loss during training, testing, and and the period immediately following the transition
  • Temporary staffing to cover gaps due to preparatory activities and productivity lags
  • Contract changes with vendors and payers
  • New coding guides/superbills

Handy tools like the free Healthcare Information and Management Systems Society (HIMSS) ICD-10 Cost Prediction Tool account for many of your clinic’s variables, but even if you cover all your bases, you can’t guarantee your payers will be as prepared as you are—and that can spell trouble for your practice. If payers aren’t prepared to process claims containing ICD-10 codes, you’ll need a contingency plan to offset any cash flow delays. Your best bet is to have plenty of cash on hand (but not under the mattress) to keep your practice afloat. So get ready, get set, and get to saving three to six months’ worth of cash revenue.

Is saving that much money not an option for your clinic? Consider turning to your bank for a new loan or increasing an existing line of credit. Fair warning: If you go this route, you’ll need to assess your practice’s financial needs and work with a partner who understands the particulars of the healthcare industry. Keep in mind that lenders usually require lots of paperwork, including:

  • three years’ worth of tax returns and year-to-date financials
  • a current personal financial statement
  • your most recent accounts receivable aging report

For more assistance regarding financial planning with your bank, check out this awesome list of ICD-10 cash flow tips from Wells Fargo.

However you acquire and allot your funds, be sure to nail down your plan soon. The transition to ICD-10 happens on October 1, 2015—just about six short months away. Will you be ready?

Seven Months Left: Your ICD-10 Survival Guide

March 24th, 2015
ICD-10, Preparation

The year keeps marching on, and we’re already fewer than seven full months away from the mandatory transition to ICD-10. It’s time to get going on your ICD-10 preparations so you don’t find yourself dead in the water come October. If your prep game is on point, then you’ve already amassed a veritable library of ICD-10 resources and determined your clinic’s ICD-10 champion (or champions). But you can’t stop there, so we’ve put together a list of what you need to do over the next seven months to finalize your clinic’s preparations for the switch.

March: The Once-Over

To make sure the transition to ICD-10 doesn’t sink your ship, you’ll need to take a good, hard look at your practice and inspect it from sails to keel, port to starboard, bow to stern, and everywhere in between. Here’s how to get your magnifying glass into every nook and cranny:

  • Determine your current diagnosis coding processes and run an ICD-10 compliance audit to ensure those processes can accommodate the new codes.
  • Figure out how your staff currently interacts with ICD-9 codes, and pinpoint the ones they use most frequently; then, learn their ICD-10 equivalents. This also is a good time to decide if you need to hire a coder.
  • Double-check with your external vendors (like your billing service, EMR, and payers) to verify their ICD-10 preparedness. If they aren’t ready or don’t even have a plan in place, you might want to take your money elsewhere. And if you’re in the market for new software, make sure you consider ICD-10 functionality when choosing your vendor—and plan ahead to give your staff enough time to get comfortable with the new program before the ICD-10 switch.
  • Cover your financial bases by creating an ICD-10 clinic budget. Don’t forget to include costs related to technological and software upgrades, training courses for your staff, and coding guides and superbills.

So, why must you dive into all these details? To develop an effective game plan. Based on the information you uncover, you and your ICD-10 champions will create a to-do timeline for your clinic that gets everyone involved and up-to-speed in a timely fashion.

April-September: Training Day(s)

At this point, spring has sprung—and we’re leaping into the final six months before the ICD-10 transition. This six-month stretch—during which you’ll enact your plan of action—will be crucial to your success. This is an all-hands-on-deck process, so remember to include even those staff members who may not be directly impacted by the switch to ICD-10. With so many different folks on your team, training can be tricky, so here are a few tips to help you lead the way:

  • Be a good DJ. Chances are, the members of your team have a variety of different learning styles, so when it comes to your educational approach, you’ve got to show off your mixing skills.
  • Bend—don’t snap. Switching code sets is a huge change, so be patient and flexible with your staff while they learn the new structure. Basically, don’t be like Denzel Washington’s character in Training Day.
  • Seize the moment. Each day is a new opportunity for you and your staff to engage in ICD-10 training, so get crackin’. Bring back some high school memories with pop quizzes, and add in practice exercises to work those ICD-10 muscles. Remember to acknowledge those staff members who really dedicate themselves to learning the new code set.

May-September: Clinic Tested; Payer Approved

The first day of fall (September 23, in case you were wondering) will be here before we know it; before that date hits, you’ll want to make sure your vendors have their ICD-10 ducks in a row. Testing for ICD-10 compliance may seem complicated, but avoiding it could lead you into rough seas once we transition to the new code set. My advice:

  • You need to test. No ifs, ands, or buts about it. Test internally and externally.
  • Again, check with your vendors. This time, make sure you know how they plan to test, if at all (though all vendors and practitioners should be testing at some point before October).
  • Once you know your vendors’ testing plans, take advantage of them to ensure preparedness for both parties. It would be bad news bears to find out after the switch that you, your partners, or—worse—all of you weren’t ready.

October 1, 2015: You Did It!

Treat yo’ self with a pat on the back, and take a moment to thank your staff for putting so much hard work into making your ICD-10 transition smooth sailing.

So, there you have it: your seven-month countdown of ICD-10 preparations. Easy peasy, right? Okay, maybe not, but I can assure you that all that prep work is well worth your time. Looking for more in-depth preparation information? Check out our webinar for a complete ICD-10 prep checklist.

Why ICD-10 KOs ICD-9

March 17th, 2015
ICD-10, ICD-9

If you get a kick out of watching diagnosis codes fight head-to-head in the boxing ring—hypothetically at least—then you’ve come to the right blog post. We’re six months out from ICD-10 implementation, and it looks like ICD-9 doesn’t stand a chance of winning (not even by way of another SGR fix). As you size up the competitors, there’s no doubt that the ICD-10 diagnosis code set is bigger and badder than its predecessor. It weighs in with nearly 70,000 codes—five times more than ICD-9’s set includes. And if you’re placing your bets based on that sheer size difference alone, then this might not seem like much of a fair fight. But keep in mind, knocking out your opponent requires more than basic brawn; you need smarts, too. Without further ado, here’s why, in the match-up against ICD-10, ICD-9 is ready to throw in the towel:

ICD-9 is a Bleeder

Okay, so ICD-9 isn’t vulnerable to actual wounds, but there are several reasons the old code set needs some cleaning up:

  1. ICD-9 is significantly older than ICD-10, but that doesn’t mean it’s wiser. In fact, at more than 35 years old, it’s simply outdated when it comes to modern healthcare standards.
  2. With only 13,000 codes, the set lacks specificity as well as the flexibility necessary for adapting to future healthcare developments.
  3. Because the current code set is so limited, much of the diagnosis data is inaccurate. And another jab? That incorrect data further fuels distorted reimbursements.

ICD-10 Goes the Distance

ICD-10 doesn’t rely on haymaker tactics, throwing wild punches to knock out its opponent. The new code set is extensive by design and has five times as many codes as ICD-9 (with mortality and morbidity data to boot). It’s complex, flexible, and designed to accommodate evolving healthcare documentation standards. The specificity of of the new code set allows for:

  • accurate data measurements of everything from quality of patient care to outcomes.
  • clearer clinical research.
  • more effective detection, verification, and response to public health threats.
  • fewer coding errors.
  • easier identification and prevention of healthcare fraud and abuse.
  • reduced claim rejections.
  • accurate provider performance-tracking.

And the Winner is?

ICD-10 KO’s ICD-9. I don’t know which contender you put your hypothetical money on at the beginning of this post, but I hope you’ve come out a little richer—at least in knowledge—in the end. Are you still a diehard fan of ICD-9? Check out this post and download the infographic to see why you should readjust your betting strategy. Do you have questions? Comment in the section below.

New Survey: Practitioners Confident in Preparation, But Concerned About Costs

March 10th, 2015
ICD-10, Preparation

The healthcare industry at large has faced the music: everyone is switching to ICD-10 on October 1, 2015. That means every HIPAA-eligible professional is finally in the full swing of preparation, but seeing as how experts have been urging folks to prepare for roughly two years now, it’s unsettling that most of those practitioners still feel unprepared. According to a Healthcare IT news article summarizing a recent survey from Navicure and Porter Research, only 21% of physician practices surveyed said “they’re on track with their preparations for the switchover.” But while physician practices are running behind the preparatory timeline, they’re not crying about it. On the contrary—they’re actually “optimistic,” the Navicure and Porter Research survey revealed. Furthermore, a whopping 81% of practices surveyed are “confident they will be ready for the transition.”

Even though private practice physicians are confident they’ll be ready before the deadline, the study did highlight some immediate concerns: According to HIT Consultant, 41% of those surveyed aren’t sure if “they’ve budgeted for ICD-10,” and 59% “are most concerned about ICD-10 cash flow impact and revenue.” Other cited concerns included questionable payer readiness and potential productivity lags. While payer preparedness is out of practices’ control, they can control productivity—to an extent. As Navicure explains in its survey report, “Even with a well-trained staff, industry estimates indicate that staff productivity will decline by 52 percent for the first 3-6 months following the transition.” And decreased productivity has a ripple effect: “Lower productivity means slower claims turnaround and slower reimbursement.”

In addition to sharing the survey results, Navicure also emphasized some key takeaways, which I’ve summarized below.

  1. Many survey respondents said they were waiting on vendor software updates to test ICD-10. My advice: Don’t wait for your vendors. There are ways to test internally without vendor involvement.
  2. Develop a budget ASAP, and investigate how partnering with your bank and improving your billing processes can help ease the financial burden of the transition.
  3. Plan for decreased productivity, and pinpoint how to mitigate it. One way to do that? “Trend denials pre- and post-implementation to benchmark performance and fully monitor revenue cycle efficiency and staff productivity,” explained Navicure.

While Navicure and Porter Research surveyed private practice physicians, the results likely ring true for many PT practices, too. Feeling a bit unprepared yourself? Don’t sweat it; check out this webinar for your ultimate ICD-10 to-do list.