Will You Be in Business After October 1, 2014?

Many small practices are expected to go out of business with the changes in ICD10. Why?

October 1, 2014 ushers in the largest change many of us have seen in medical billing and coding as the US adopts ICD10.  The changes are sweeping. According to the CDC, there are almost 19 times as many procedure codes in ICD10 as ICD9 and almost 5 times as many diagnosis codes.  These new codes require changes to your EMR, billing platform, payers coding edits and more…including greater specificity in documentation on the part of the clinician.

With a major change such as this, there are bound to be hiccups and the predictions are not nice.  The biggest issue I keep hearing about that affects practice owners is to expect delays in payment.  Major payers, including Medicare are predicting delays of up to 4-6 months.  Bottom line…expect a major cash flow crunch.

What can you do now to prepare?

• First of all, take steps to learn ICD10 – for you and your staff. Remember that in any system, people are the weakest link.
• Take a look at the 100 most common ICD9 codes that you utilize. Map them into ICD10 codes now.
• Assess how your documentation might need to be adjusted, if at all. Pay attention to causality, chronicity, sequela, specificity, laterality and timing.
• Assess everything in your office that touches a ICD9 code. What documents or forms need to edited for ICD10?
• Talk with your EMR vendor, your billing and gateway people and find out what you may need to do on your end to interface with their system. Are they ready?
• Prepare financially….we’ll talk about that below.

Let’s talk money.

Worse case scenarios are to be pointing to delays in payment, which means little to very little cash flow coming into your office.

• Take a good hard look at cash flow now. Assess your accounts receivable and make sure appropriate staff are doing everything they can to keep that as low as possible. Your AR is money that is due you and someone else is holding on to it.
• Examine claims that are currently being denied. Do you need to make changes in your coding and billing? Are there other issues that need your attention?
• Assess your front desk. Are they collecting co-pays, co-insurance, deductibles at the time of service. What training and support do they need in order to improve?
• Take a hard look at your overhead. Does it really need to be as high as it is? Are you paying for redundancies? Are you replenishing supplies unnecessarily? Are you paying for services or items that are no longer appropriate or needed in your practice?
• Do you have access to savings that will cover your practice expenses for 4-6 months if necessary?
• Consider establishing a business line of credit for your practice with your local banker.
• Have a conversation with your CPA for other suggestions.

While all this sounds dramatic and fatalistic, this is clearly a time when being prepared may just be what the clinician ordered.  If you are a practice who has  not yet taken action, now is the time to do so. Being prepared means that come Jan 2, 2015, your door will be open.

ICD-10 Resources:

• CDC ICD10CM Background
• CMS ICD-10-CM/PCS Billing and Payment FAQs 
• HIMSS – ICD-10 Transformation: Five Critical Risk-Mitigation Strategies 
• CMS Road to 10: Built for small practice, this tool will help you get up to speed on ICD10