NEW YORK, Jan. 14, 2014 /PRNewswire/ — The implementation of ICD-10 on October 1 presents a challenge for private practices, especially those who have still not made preparations for the changeover. Technical difficulties could result in undue financial stress and glitches similar to those that hamstrung the rollout of HealthCare.gov. Health care consulting firm Creative Practice Solutions has monitored the long development of ICD-10 and has offered some actionable suggestions for those private practices uncertain of how to proceed.
Diagnostic codes are the virtual currency ensuring that health care providers are properly reimbursed by their respective payers and that disease incidence and trends can be closely studied. The World Health Organization creates and updates these codes in the interest of international comparability. ICD-9 has been the standard since the mid-70s; a major update has arguably been long overdue.
The rollout of ICD-10 will mean an expansion of diagnostic codes from about 13,000 to a staggering 68,000 unique codes. In many cases, one or a few ICD-9 codes will soon be represented by entire pages of ICD-10 codes. More information on this new set of diagnostic codes and what it means for everyone in the health care industry is available from the Centers for Medicare and Medicaid Services: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10_Introduction_060413[1].pdf.
The potential pitfalls facing private practices in the last quarter of 2014 are numerous. System overhauls, both locally and at the submission clearinghouses and billing services, almost never go flawlessly. A single computer glitch can cause an epic logjam in an already cumbersome network. Likewise, the added complexity will require all parties to be attentive to detail. If one component in the health care payer system lags behind the others, then compatibility issues could bring everything screeching to a halt.
To make matters even more complicated, each commercial insurance carrier will have their own coding policies for ICD-10. Failure to stay abreast of these policies will result in rejections and delays, meaning doctors not getting paid.
Private practices can learn from the past to be better prepared for the future. In 2012, the standard electronic submission format for medical billing was modified in anticipation of ICD-10; weeks into this transition, serious problems became apparent. Glitches and shifting requirements left many private practices in a revenue crunch before the issues could be sorted out. It was a slow, laborious process to identify and correct all of the submission errors and restore cash flow to normal volume. Private practices could see a repeat of this headache if adequate preparations are not in place before October 1, 2014.
Creative Practice Solutions offers the following suggestions for getting up to speed with the implementation of ICD-10: first and foremost, being proactive in response to the looming October 1 deadline requires building up a healthy financial reserve, such that hiccups in the rollout do not affect an office's ability to manage its overhead. Likewise, the forward-thinking private practice will communicate with payers and submission clearinghouses to ensure all are on the same page. In the first days and weeks of the ICD-10 rollout, private practices may benefit from sending out smaller batches to the clearinghouses. This can prevent the wasting of time and effort should a link in the chain become broken.
When the wrinkles are ironed out, ICD-10 will result in more satisfactory health care services and a more nuanced understanding of disease and epidemiology. Creative Practice Solutions encourages private practices to see this as an opportunity for better care delivery rather than a needless bureaucratic burden.
About Creative Practice Solutions
Creative Practice Solutions is a business consulting company geared towards Medical Professionals. With over 26 years' experience in Healthcare administration, they have improved the functioning, efficiency and collections of both private practice and outpatient hospital departments throughout New York City. Their sister company, VGA Billing Services, Inc., collected over $14 Million for their clients in 2012.
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