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The Gathering Storm

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Despite repeated delays, ICD-10 will eventually become a reality

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It’s setting up to be a modern day version of Aesop’s “The boy who cried wolf!” After three implementation delays by the Centers for Medicare & Medicaid Services (CMS), many healthcare providers are looking at the new October 1, 2015 implementation date with a healthy dose of skepticism. While this jaded response is clearly understandable, it’s also worrisome in that lack of advanced preparation for ICD-10 could be nothing short of cataclysmic for your practice.

Make no mistake about it, whether or not the industry receives another temporary reprieve or not, at some point in the not too distant future, ICD-10 will go into effect and it will change everything. It’s going to touch not just every physician, but every single person in your organization – the way you bill, the way you code, and the way you post.

Harken back to the furor that surrounded 2012’s HIPAA 5010 implementation. What was solely a transaction standard change, intended to begin preparing the industry for ICD-10, and with no anticipated payment delays wreaked such havoc that some practices were poised on the brink of filing for bankruptcy. In many instances, providers were not receiving payment from payers for 90 days or longer. Firms were scrambling to establish lines of credit to weather the storm, and some smaller practices were unable to pay their employees because of the lack of cash flow. Payer systems simply weren’t fully ready, they weren’t fully tested, and as a result they pended claims and weren’t making payments until they could figure out how to fix the systems.

Now, take that scenario, multiply it by a factor of ten, and you have some semblance of an idea as to the far greater magnitude of changes associated with ICD-10 have the potential of being. And while this may sound a bit alarmist, make no mistake that the projected costs and delays are significant. It’s not merely that the number of codes will increase from 17,000 to 140,000; it’s the corresponding rise in costs, anticipated increase in denials, decrease in productivity and payment delays that also have to be considered. The latest 2014 data suggests that:

  • The average annual cost of running a post-ICD-10 practice
    will be 3X what it cost in 20081
  • The expected number of denials will also triple1
  • Staff productivity is expected to decrease by 30% to 50%
    and will take upwards of a year to rebound to 90%1

Healthcare providers can establish robust lines of credit well in advance of ICD-10, knowing that inevitably there are going to be payment delays until systems are fully tested.

By postponing implementation for a year, CMS is affording healthcare provider organizations a short window of time to focus resources on projects and initiatives that will serve as a critical foundation in advance of ICD-10, such as payment automation and reconciliation solutions like SunTrust’s eClaim Revenue Gateway®. And a great many providers are already invested a considerable amount of time and money and time in preparing and testing automated systems.

The bottom line is that eventually ICD-10 will arrive. In the interim, your goal should be to fix as many things internally as you can, so that when the time does come, you’ll be better prepared and able to re-allocate human resources to the implementation.

Disclaimers

1 "The Cost of Implementing ICD-10 for Physician Practices," Nachimson Advisors LLC, February 2014

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