Although the changeover to ICD-10 will affect virtually everyone in healthcare, there’s a consensus among experts that general practitioners will have an easier time than specialists. The question then becomes: Which specialists will be most affected, and what can they do to mitigate the effects?
Our billing experts predict that orthopedists will have one of the most difficult transitions, followed by ophthalmologists, cardiologists and neurologists. A team of researchers at the University of Illinois at Chicago concluded that hematologists and oncologists would likely have the easiest transition, and that obstetricians, psychiatrists and emergency medicine physicians will face the most challenges.
The complexity of the body system and the way ICD-9 codes were constructed versus those in ICD-10 both contribute to the degree of difficulty of the transition.
Strategic planning is key to risk reduction—in this case, lowering the incidence of incorrect codes and rejected claims. All medical practices must prepare, but specialists should start as early as possible and be especially thorough. Ask yourself:
- Who in the practice will lead this project? Having a designated lead will help keep the project on track and keep strategy and training questions directed to a certain individual.
- What is our training strategy? Who will get training, when will they get it, who will conduct it?
- Who will contact the vendors to ensure their ICD-10 status? This includes your billing service, clearinghouse, practice management system and EHR.
- How will we determine which payers (if any) haven’t made the transition, and how will we handle it? Those payers will need claims with ICD-9 codes.
- Who needs an anatomy refresher? Consider your medical assistants, nurses and in-house billers. Hold some practice sessions to see who needs training in this area (e.g., name the parts of the meniscus and the various types of tears).
With the changeover beginning Jan 6th, 2014 with the advent of the new dual-mode CMS 1500 Form, it’s time to complete planning and begin training. Aim to have your initial round of training complete in advance of April 1st, 2014 which is the cutoff for the old standard CMS 1500 claims form. That gives you several months to conduct gap assessments for each role and department, see where additional training is needed, review your medical billing software needs, and have your staff complete ICD-10 training.
Now is also time to create a budget for the project, which should include training, hardware, software, and licenses. Estimates vary, depending on the source and the size of the practice, but Stanley Nachimson Advisors puts the cost at $83,000 for a small practice (up to $2.7 million for large healthcare systems). Research by the Medical Group Management Association (MGMA) finds the average cost for a 10-physician practice to upgrade or replace their practice management system and EHR software is $201,690. Note that some of the transition costs will be absorbed by your billing company, if you outsource this function.
Investments made in early 2014 will pay off as the deadline draws closer, leaving you well prepared for a smooth fourth quarter.