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It’s Too Late to Ignore ICD-10


Practices that are not ready for ICD-10 will have to deal with significant issues, so it’s time for them to seek guidance from payers and others.

As Oct. 1 quickly approaches, healthcare providers are scrambling to get ready for ICD-10.  Various reports indicate that up to one-half of physicians are not ready, while the other half says they are unsure whether they will be ready!  These numbers are based on an Aug. 3, 2015 survey by the Workgroup for Electronic Data Interchange (WEDI), which also notes that three-quarters of hospitals report being ready for the new codes under ICD-10. 

What does “not being ready” really mean?  Most likely, lack of ICD-10 preparation will lead to workflow disruptions, lags in patient care, disruptions in claims processing, and most importantly, a delay in reimbursement.  For this reason, physicians have been urged over the past couple of years to get ready for ICD-10 without delay.  To help move this process along, the American Hospital Association has even come up with an ICD-10 checklist, which provides step-by-step preparations to prepare for the Oct. 1 deadline (http://www.aha.org/content/15/icd10checklist.pdf). 

While there are certainly benefits to upgrading to ICD-10, such as more accurately capturing care and better monitoring of outcomes, costs, and resource utilization, it’s hard to not be overwhelmed at the costs involved in this transition.  I have seen estimates that small practices will spend a significant amount of money to implement ICD-10, while medium-sized ones will spend even more.  These costs are staggering for physician practices already struggling financially.  Moreover, once converted, there may still be ongoing expenses for practices related to upgrades, training, and other productivity interruptions.

The ICD-10 switch may also introduce potential additional liability for providers, who engage in self-audits in an effort to remain compliant with the new system.  Since self-audits could reveal technical and other errors while adjusting to the ICD-10 system, providers must be aware that audit findings that go unaddressed can be considered false claims (see my prior blog on handling the results of audits). 

What is interesting to me is how differently some physicians have ended up handling the ICD-10 “crisis”:

• Many physician clients have actually done their homework and prepared for the change.  They have worked with their EHR vendor and staff to test and anticipate the issues and have started trying out ICD-10 to work out any potential kinks in the system.  They have also staffed training clinical and medical billing staff, and have developed an ongoing dialogue with their vendors and other parties that may be affected by the change to ICD-10. 

• Some physician clients have sold their practices and/or retired from the practice of medicine, all to avoid ICD-10.  In these instances, the physicians will either end up working for somebody else who will deal with ICD-10 or have simply decided that they no longer can practice medicine.  Most likely, ICD-10 is only the tip of the iceberg for those physicians who decide to call it quits. 

• A few physician clients have decided to continue practicing by using a different model, such as opting out of insurance completely and switching to concierge models.  Their sole motivation in many cases has been to avoid the frustration they feel in having to deal with payers and the change to ICD-10.  While they embrace the concierge approach, few of them would have been motivated to modify their practice had ICD-10 not been imminent.

• The most worrisome group of physician clients are those who have yet to prepare for ICD-10, nor made any changes in how they will practice going forward.  I assume in such cases, they are praying everything will work itself out, or perhaps they are relying on their billing companies to handle issues that may arise. 

There is no turning back now, so we can only hope the switch to ICD-10 is smoother than anticipated and that payers will work cooperatively to assist providers through this process.  I urge all physicians who are still unprepared to seek appropriate guidance as soon as possible.  It’s time to acknowledge that ICD-10 can no longer be ignored.

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