Healthcare Leaders, Practices Anticipate Revenue Loss in ICD-10 Transition

If your practice hasn’t embraced the new ICD-10 codes and 5010 upgrades, you’re in good company. And a new report released earlier this month may shed some light on exactly why that is. 

As it turns out, practices are bracing for major revenue losses with the onset of the new code set, which takes effect Oct. 1, 2013. Just 36 percent of 722 physician practices who answered ICD-10 questions in our 2011 Technology Survey said their technology is ready for the coming transition to the new code set, which will require practices to start using more than 100,000 new alphanumeric procedure and diagnosis codes.

Learning the new codes will require hours of training and a greater level of documentation. Translation: A potentially hefty financial investment from your practice.

According to the HealthLeaders Media Intelligence Report, “ICD-10 Puts Revenue at Risk,” many healthcare leaders (46 percent) anticipate a substantial revenue loss from ICD-10 implementation. What’s more, physician cooperation is cited by as the top challenge. And 53 percent of healthcare leaders either don’t expect to, or are unsure if they’ll recoup their investment.

With all this in mind, what’s a cost-conscious physicians practice to do?

For starters, make sure software systems are upgraded to meet 5010 requirements (the deadline is the last day of 2011, so you’ll want to avoid the rush). Next, make a plan to start training physicians and staff early for the forthcoming changes. Most practices and healthcare consultants we interviewed for our September ICD-10 magazine story said that it takes dozens of hours to get used to the new alphanumeric codes and the logic that dictates how to apply them.

In June, the Medical Group Management Association (MGMA) released results for its survey of 359 physician practices on 5010 readiness. Even though most medical groups rely on their practice management system software to conduct HIPAA electronic transactions, just 29 percent of respondents believed their current practice management system would allow them to use Version 5010; 50.3 percent of respondents stated that their software would require an update.

Almost half (45.2 percent) of respondents said they hadn’t even started implementation.

Robert Tennant, a senior policy advisor for the MGMA, told us there are a number of barriers to 5010 implementation, not the least of which is cost.

“There are a number of issues here beyond even what we’ve been discussing in terms of partner readiness,” Tennant told Physicians Practice, adding that “there’s no proven ROI with 5010 and ICD-10.”

In a press statement, William Jessee, MGMA president and CEO, voiced the same sentiments.

“This is a significant expense for a medical practice in this challenging economy.”

We want to hear from you. To what extent is cost a barrier to 5010 and ICD-10 implementation? Is your practice concerned about revenue loss? Post your response below.