ICD-10 to Bring Big Changes: Learn how to prepare for the new coding system

Financial Concerns

Implementation will be costly. A white paper developed for America’s Health Insurance Plans in 2006 suggested a total cost of between $3.2 and $8 billion. A 2008 study by Nachimson Advisors, LLC, estimated that a typical small practice of three physicians can expect costs of more than $83,000 by the time the changeover is complete. A practice of 10 providers may spend as much as $285,000 to fully implement ICD-10.

In addition to having to come up with the money to pay for computers, software and staff training, companies have very real financial worries about timely payments during the changeover.

There is no consensus developing about how smoothly payments will flow in early October 2013. Credible scenarios have included everything from no discernable difference to checks being held up for three months or more. Over the constellation of payers, it is likely that some will be better prepared than others.

“Practices definitely should be trying to put money in the bank and arranging lines of credit,” said Kim Pollock, RN, MBA, CPC, a consultant with KarenZupko & Associates, Inc., a Chicago practice management consulting and training firm. “You might be entirely ready, but if there are glitches at the payer’s end, you won’t get paid. Payments are not entirely in the practice’s control.”

Robert Tennant, a senior policy advisor with the Medical Group Management Association (MGMA) in Washington, D.C., suggested that practices consider putting off major capital expenses in the two to three months leading up to the compliance date. Think hard about the immediate need for a new piece of diagnostic machinery, expansion of the office or any other big cash expenditure in the run-up to ICD-10.

“ICD-9 is completely outdated. Not only is there a need for more codes, but [there is] a lack of space for new codes.”

—Rhonda Buckholtz, CPC, CPMA, CENTZ

How Specific?

Another financial concern will be payer policies. Even CMS is unable to give guidance about the level of specificity that will be required.

“Both systems have a code for unspecified sinusitis,” Tennant said. “One health care plan says 82 percent of sinusitis claims use that code. We are concerned that there is no clarity on whether plans will continue to pay ‘unspecified’ claims at the same rate, a lower rate or reject them.”

Even when there is more transparency on how plans will handle this, individual practices may still not know what to expect when a specific patient walks in the door.