Survey Says: Providers Lack ICD-10 Readiness

February 24th, 2014
ICD-10, Preparation, Transition

If you’re feeling less-than-ready for the impending transition to ICD-10—set to blast off in T-minus eight months and counting—you’re definitely not alone. In fact, a recent survey by the New York-based healthcare advisory firm KPMG found that nearly three-quarters (73%) of respondents—including health plans, hospital and health system-affiliated providers, large physician groups, and nurses—predicted that ICD-10 would have a moderate to severe impact on their bottom lines. Furthermore, 67% of survey participants admitted that they had yet to conduct end-to-end ICD-10 testing with outside vendors, payers, and software systems.

In this article about the survey, Wayne Cafran, advisory principal in KPMG’s Healthcare & Life Sciences practice, estimates that the organizations in question could suffer financial losses of anywhere from $1 million to $15 million. “Healthcare organizations are in for a rude awakening when they finally realize what [impact] the new standards will have on their bottom lines,” Cafran said.

Following the rules of probability, there’s a solid chance your practice falls into one or both of the groups cited in this study. Which begs the question: If so many players in the healthcare arena aren’t adequately prepared for the switch, how can it go forward? That’s the (literally) million-dollar question many medical providers and organizations are posing as they scramble to adjust their processes to accommodate an entirely new—and much more complex—diagnosis coding system.

In fact, the American Medical Association (AMA) has been very active in building a case for another extension to the ICD-10 deadline. As part of that effort, the group asked physicians to complete a ten-question survey about software readiness. The crux of their argument is that many vendors won’t have their ICD-10 upgrades in place until well into 2014, which doesn’t leave much time for providers to adjust to any changes and work out the kinks. According to the article cited above, the AMA has twice been successful in similar lobbying efforts. But don’t get too excited; as this article explains, the chances of another pushback are slim to none. The fact of the matter is that ICD-10 is coming—whether you like it or not.

So, instead of wasting your time wishing for an extension that’ll probably never happen, you’re better off investing your time and energy into crafting a plan to get your ICD-10 preparations back on track. Need help? Check out the resource page on to download an ICD-10 checklist and a step-by-step guide on preparing your practice for the transition.

Should Your Practice Hire an ICD-10 Coder?

February 17th, 2014
Codes, ICD-10, Preparation, Transition

The switch to ICD-10 will trigger a monumental shift in the way medical practitioners code patient diagnoses. In addition to an entirely new coding structure—ICD-10 codes contain up to seven characters, whereas ICD-9 codes max out at five—ICD-10 incorporates much more advanced anatomical terminology. Furthermore, in addition to coding for patients’ conditions, you often will need to submit supplemental codes to describe how and where certain injuries occurred as well as their degree of severity.

The result is increased specificity in coding, but all that slick, souped-up data comes at a cost—time. And as a rehab therapist, you don’t have a lot of that to spare. So rather than trying to manage the transition—and master a code set with five times more codes than the library you’re used to—all by yourself, you might want to consider calling in some backup in the form of an ICD-10 coder.

Medical coders are trained to review clinical documents and patient records and assign numeric codes for each diagnosis and procedure. So basically, when you have a coder, he or she will take your patient notes and translate them into the correct codes. Those codes help paint a clear picture of a patient’s condition and treatment, thus justifying reimbursement from payers.

Unlike large-scale medical organizations (such as hospitals), most small practices do not have dedicated coders, and with ICD-9—which features only about 13,000 codes to ICD-10’s 68,000—that might work just fine. But beginning October 1, 2015, if your practice fails to record and submit the proper ICD-10 codes, you won’t get paid. That’s a lot of pressure to deal with on your own—and that’s where a pro coder can help. Now, your gut reaction is probably, “There’s no way I can afford to hire a dedicated coder.” But considering the potential revenue loss your practice could suffer if you do not code correctly, the investment might be well worth it.

As this report explains, “The medical coders’ role in assuring that all information is accurate and complete is crucial to the economic well-being of the hospital since their entries determine the amount of reimbursement for patients covered by Medicaid, Medicare and other insurance programs. Coder efficiency in timely processing of coded bills maintains the flow of income into the institution.”

To code effectively, such professionals must demonstrate mastery in specific code sets and the ability to translate specific documentation into codes. For that reason, coders competent in ICD-10 are already in high demand among large institutions that currently retain on-staff medical coders. But as I mentioned above, ICD-10 could prompt smaller clinics to invest in trained coders as well—which in turn would drive up the demand even more. So, if hiring a coder to optimize your clinic’s ICD-10 coding and ensure reimbursements sounds like an attractive option to you, you’ll want to start looking for one sooner rather than later. Remember, you don’t necessarily have to add a full-time, in-house coder to your payroll; if you’d rather outsource to a third-party company (which is typically a much less expensive option), there are plenty of good ones out there. Check out the list at the bottom of this article for some suggestions.

And if bringing a coder on board simply isn’t in the cards—or the budget—for your practice, I would highly recommend sending your clinic’s current coding hat-wearer to an ICD-10 training course or two.

How is your practice planning to handle the switch to ICD-10? Would you consider hiring a medical coder? Share your thoughts in the comment section below.

5 Steps You Can Start Taking Today to Prepare for ICD-10

January 22nd, 2014
ICD-10, Preparation, Transition

So, you’ve heard: ICD-10 is coming—dun, dun, dun. Just kidding about that last part. While there are several preparatory tasks we really think you should get started on now (if you haven’t already), ICD-10—contrary to what some people believe—is nothing to be afraid of. But it is something to take seriously. So what can you do to prepare? Well, here are our top five next steps and when to take them:

1. Accept the facts (today)

Sure, you could go through all five stages of Kübler-Ross’s mourning process before finally landing on acceptance, but we suggest you make it a quick trip. Beginning on October 1, 2015, you will only receive reimbursement for claims you submit with ICD-10 diagnosis codes. The sooner you accept this fact, the better. Use this as motivation—you have a deadline. And I don’t know about you, but I sure work better with a firm end date.

2. Elect a lead—or a team (this week)

There’s someone in your office who excels at this sort of thing—and that may or may not be you. This person is a born project manager with a knack for research and a love of all things organizational. This is your ICD-10 implementation lead, so go buy him or her a coffee—or maybe a personal espresso machine.

Depending on the size of your office, you may need to elect an ICD-10 team, but at the very least, every practice needs one head ICD-10 honcho who is responsible for staying up to date on the latest and greatest in the world of diagnosis codes—and translating that information into comprehensible tidbits and action items for everyone else. Looking for a place to start? Assign your lead the first task of compiling a list of great ICD-10 resources like CMS, APTA, and AdvancedMD. (Bonus points if he or she puts WebPT at the top of that list.)

3. Create a plan (next week)

Now that you’ve got your lead and a host of really helpful resources, it’s time to start laying out a plan—that is, what you want to accomplish by when. Just like you do for your patients, we recommend using the SMART goal method—setting learning objectives that are specific, measurable, attainable, realistic, and timely. You can start by taking a look at your current diagnosis code processes and determining how these will need to change in the coming months to accommodate the new codes—an ICD-10 compliance audit, if you will.

And it’s not just about your internal processes. If you outsource your billing or use an electronic medical record for documentation, make sure that your vendors are ready to handle the new codes as well. If they aren’t prepared—or don’t seem confident in their ability to transition—you may need to start looking for new partners. (In case you’re wondering, WebPT will be ready to handle the new codes well before the October go-live date, and we’ve made it our mission to provide you with a wealth of free educational resources so you’ll be prepared, too.)

You could spend every waking moment between now and October 1, 2015, preparing, and you still might hit a snag or seven when it’s time to submit—not on your end, but on your payers’. That’s why experts recommend having at least six months’ worth of cash revenue available to ensure you can weather the potential storm of delayed reimbursements. If you can’t save this much in advance, Heidi Jannenga suggests “having a plan B, such as a line of credit or supplemental income to ensure your clinic’s viability during the transition.” She cautions not to “wait until after October 1 because you’ll have to vie for financing and pay higher interest rates.”

4. Start training (next month)

You’ve got your lead, and you’ve got your plan. Now, it’s time to begin training—and that means including everyone in your office, whether it seems immediately beneficial or not. As an industry (and as a nation), we’ve been using ICD-9 codes for the past 30 years, and it’s going to take a while to unlearn what we’ve learned, so start sooner rather than later—especially because there are five times as many ICD-10 codes as there are ICD-9 codes. Whereas ICD-9 codes are mostly numeric and have three to five digits, ICD-10 codes are alphanumeric and contain three to seven characters. While that may not sound like a big difference, it is.

As you begin training, pay attention to what your trainees need in order to be successful. Are they audio, visual, or hands-on learners? Knowing this will help you and your lead train effectively. Look back at your list of resources; there is a lot of great information out there in a variety of formats. And as the year wraps up, even more resources will begin to surface.

5. Test, test, test, and test some more (next year)

  1. AdvancedMD succinctly summed up this stage in three sentences:
  2. “Test that your office staff can competently work with the redesigned workflow [and new codes].
  3. “Test each redesigned process.
  4. “Test integration with partners.”

Beginning on the first of the New Year, your clinic should be almost (you still have your patients after all) singularly focused on ensuring that come October 1, 2015, you’ve got ICD-10 on lock. That is, you and your staff know the ins and outs of the new codes and how to properly use them, as do your partners (billing, documentation, etc.). So start testing and keep testing until you are 150% confident.

Interested in seeing a few other suggested timelines? Here’s one from AdvancedMD and one for small- to medium-sized practices from CMS. Now, it’s important to note that both timelines suggest that ICD-10 preparation should have begun months ago, but not to fret. There’s still plenty you can accomplish in the time you have left. You’ll just have to step on the gas, pick up the pace, give it some gusto—you get the idea.

Have you started preparing? If so, what steps have you found most useful? Tell us your thoughts in the comments below.