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FACT or FICTION

Three ICD-10 myths that could cost you BIG

i recently sat down with a client to help plan for the sweeping changes coming for his practice. He seemed quite calm about the shake-up in healthcare.

“We have been diagnosing our patients for years,” he said. “I only see a few Medicare patients a day, so the impact won’t be that big of a deal. Besides, my software vendor is taking care of all of that.”

Like so many ECPs, that client has gleaned only snippets of information on the change to ICD-10, and has fallen victim to many myths about the change process.

Here are three of the most widely held myths that could cost you big bucks come October 1.

MEDICARE

FICTION: “ICD-10 is just for Medicare, right?”

FACT: No. No, no, no. The ICD-10 changeover is applicable to all HIPAA-covered entities, which include all major health plans and any entity that utilizes electronic transactions for healthcare services. Effective October 1, all patient encounters need to be documented and coded for ICD-10 per federal mandate. Any claims sent in to these entities on or after the effective date utilizing ICD-9 codes will be denied as not recognizable.

TO DO: This means you need to be preparing yesterday to make sure your office staff is trained and ready for this change and that you are prepared to handle the documentation requirements to correctly assess the diagnosis code(s) for services. If you are not prepared, the impact will be immediately and thoroughly felt in your bank account.

According to a recent study by the American Medical Association (Nachimson Advisors, The Cost of Implementing ICD-10 for Physicians Practices…), medical providers will spend on average anywhere from $56K to $8M, depending on the size of the organization, to implement and manage this change. This is coupled with the requirements to adopt or upgrade technology, revamp office workflow, train office staff, and make sure, while doing this, to provide and document quality healthcare for patients.

WHO’S WHO: It is not Medicare making these changes; it is Health and Human Services as part of your federal government along with the World Health Organization and CMS, implementing a much-needed change that affects the full healthcare system.

SOFTWARE

FICTION: “My software vendor is taking care of all of that ICD-10 transition stuff.”

FACT: Software vendors have also been under the gun to implement software that is up to the federally mandated standards. It is not an easy task. The final rule for ICD-10 implementation was issued in January 2009 along with the adoption of the 5010X standards, but the actual layout of the requirements for the transaction set was not issued to software vendors until July 2011.

If you couple this with the time frame those vendors have been given to continue to provide certified Meaningful Use software along with quality reporting requirements—and also rewrite their code for this massive implementation—it has not given them a great deal of time. The delay of ICD-10 implementation from October 2013 to October 2014 was due to this delayed finalization. In other words, they are under the gun, too.

TO DO: As with everything that you do for patients, it will never be the software or hardware vendors’ responsibility to keep you up to code. The joy of that falls squarely on your shoulders. Your vendors should be available to help you make the crossover and should be able to provide training on implementation of the software itself.

TRAINING

FICTION: “My staff doesn’t diagnose the patient; I do!”

FACT: Staff training is something often left until the last minute. Your staff handles 20 to 60 percent of your patient encounters—from scheduling right down to possibly documenting the chief complaint and HPI for the visit. They have the most contact with patients and are the ones who will be determining if the visit is medical or preventative and providing the documentation needed for you to get your job done.

TO DO: If your coding and billing staff is not trained on the new code set and its documentation requirements, you may be losing big bucks on the back end. The time to start your education has come and gone. If you choose not to jump in, you may be on the losing end come October 1.

— Krystin Keller

Krystin Keller is an instructor and consultant to Cleinman Performance Partners, a business consultancy specializing in the development of high-performance optometry practices.
©2014 Cleinman Performance Partners, Inc.