Countdown to ICD-10 Winds Down as October 1 Start Date Approaches

by Kimberly J. Retzlaff •

In particular, three groups and levels are integral to ensuring proper staff training:

  • Administrative staff (e.g., schedulers, receptionist)—overview and general understanding of the new ICD-10 code structure;
  • Clinical staff (e.g., physician assistants, nurses, nurse practitioners)—clinical concepts and level of detail in ICD-10 for documentation purposes; and
  • Physicians and coders—clear understanding of the new code structure, coding guidelines, and conventions related to specificity.

In addition to receiving in-depth training on ICD-10, coders who hold a coding membership from the AAPC will need to complete a proficiency assessment by Dec. 31, 2015, to satisfy their certification maintenance requirement.

In many cases, physicians are relying on their electronic medical record vendor or their institution for training or to ensure a smooth transition.

“There’s going to be a tremendous amount of variability,” Dr. Waguespack says. “For example, in large academic institutions like the one I am in, a lot of the groundwork will have been done by their institutions. The challenge is to make sure it trickles down to individual practitioners and that the tools people need to report correctly are factored into EHRs and are otherwise available to them.”

Budgeting and Financial Considerations

Staff training time and resources are important, although this constitutes a financial consideration in the transition. Training time, software upgrades, and other considerations are all rolled into recent projections on the cost of implementing ICD-10 across the U.S. The total cost is projected to be significant.

The Nachimson Advisors, a Baltimore-based health IT consulting firm, released a revision to the 2008 study on the costs of ICD-10 implementation that projects higher costs than originally estimated for practices of all sizes. The practice definitions were small practice (i.e., three physicians and two administrative staff), medium (i.e., 10 physicians, one full-time coder, and six administrative staff), and large (i.e., 100 physicians, 64 coding staff, 10 full-time coders, and 54 medical records staff). The updated projections from 2008–2014 include the following:

  • Small practice: $83,290 vs. $56,639–226,105;
  • Medium practice: $285,195 vs. $213,364–824,735; and
  • Large practice: $2,728,780 vs. $2,017,151–8,018,364.

The revised projections are the results of adding in tasks that were not considered “critical” in the 2008 study, which includes testing as well as projections for payment disruptions.

There will be a period of time in which claims need to be processed in both formats, depending on dates of service. Billing professionals will have to be extra vigilant and watch service dates for a while to ensure that claims are processed correctly.

It is generally expected that there will be an increase in denied claims and delays in reimbursements as the country gets used to ICD-10. AMA predicts, “You will have disruptions in your transactions being processed and receipt of your payments. Physicians are urged to set up a line of credit to mitigate any cash flow interruptions that may occur.” Planning ahead and having cash reserves on hand to keep business moving while these difficulties are sorted out could make the difference.

Getting Ready

Although there is continued contention about whether the switch to ICD-10 is the right move for the U.S., the reality is that ICD-10 is coming, and the clock is running out. Many hospital systems, multispecialty groups, and physicians’ offices have begun implementation efforts and training for their staff. Those who have not are encouraged to get started quickly.