The Top 5 Risks ofthe ICD-10 Transition

Transitioning to ICD-10

BENCHMARKSYSTEMS

One of the most important things your practice can do before the October 1, 2015 ICD-10 deadline is to start preparing for the transition as soon as possible. It is absolutely essential to know what the transition to ICD-10 will mean for your practice and the industry, and it’s also important to know how to avoid the pitfalls that lie in wait for the unaware.

Think for a second about how your practice operates: what the day to day happenings look like, how you get patients in and out of the door, how you bill them, what diagnosis codes are used by your practice and your payers to get you paid. Now, think about what it will mean when those diagnosis codes change dramatically. What will it do to your billing operations? How will it change practice productivity if yours is not prepared for the ICD-10 transition? This is exactly why it’s important for your practice to begin preparation for ICD-10 now.

Graham Tiggs, author of the KLAS report, told FierceHealthIT, “I think that, quite frankly, if a provider does nothing and is not prepared to cut over (to ICD-10)…they will not be able to get a bill out (of) the door and be reimbursed for it.”

© 2015 Benchmark Systems Rev.08/11/15

Lack of vendor preparation

Lack of payer preparation

Insufficient training

Reduced productivity

Financial risk due to cash flow problems

The Top 5 Risks of the ICD-10 Transition

1

2

3

4

5

The ICD-10 regulations and increased complexity compared to ICD-9 will require your practice to adapt in order to succeed. Your practice will likely experience changes in superbills, IT system changes, increased documentation costs and cash flow disruption, and that is only if you have prepared for the ICD-10 transition. For those practices that choose to wait to prepare, they should also prepare to fail.

Below, we have listed the top five major risks of the ICD-10 transition that your practice should expect and prepare for:

Figure 1: Practice Perception of Vendor Readiness for ICD-10

BENCHMARKSYSTEMS

Source: “ICD-10 Implementation Snapshot Study,” Aloft Group, February, 2013

Risk 1: Lack of EHR, Billing, and PM Vendor Preparation

EHR, Billing and Practice Management vendors may promise that they are ready for the ICD-10 transition, but studies have shown differently. View the results from a study done by the Aloft Group in Figure 1, for example.

The transition to ICD-10 will not be easy for your practice, and unless your vendors are well prepared and able to provide your practice with the training, education and assistance you will need to make the transition, the result could severely hurt your practice.

Check out our sidebar, “Is your vendor ICD-10 ready?” to learn about the ten questions you should ask your vendors before the ICD-10 transition.

© 2015 Benchmark Systems Rev.08/11/15

Not an adequate level of support

0% 10% 20% 30% 40% 50%

Not enough guidance

Can’t help with training on our end

Not an adequate schedule in place to ensure we will be ready before

the deadline

Lack of troubleshooting skills

Other

27.6%

41.0%

28.8%

43.6%

17.3%

32.1%

Risk 2: Lack Payer Preparation

There is a very real chance that, like your vendors, your payers will also be unprepared for the ICD-10 transition. In a survey of payers conducted in 2012, 39% admitted that they were not likely to be ready for the ICD-10 transition by the cutover date.

This lack of preparedness means that as a practice, you will need to be prepared to submit claims using both ICD-9 and ICD-10 diagnosis codes. In addition, your practice should be ready to monitor the readiness of each payer, so you know which payer will receive which form of diagnosis code.

In order to avoid this problem, try and find vendors that will provide systems that can help your practice easily submit the right codes to

© 2015 Benchmark Systems Rev. 08/24/15

Is Your Vendor ICD-10 Ready?Ask them these 10 questions today.

In order to assess whether your vendor isgoing to do what is necessary to prepareyou for the transition to ICD-10, CMIOIndustry News suggests that you ask your vendor these questions ten questions:

1. What is covered by our contract?

2. What are your plans and timeline for ICD- 10?

3. How will systems work with both ICD-9 and ICD-10 codes?

4. What does the implementation process include?

5. Is there a cost associated with training and support?

6. Will you need additional infrastructure and software?

7. How will you upgrade your existing interfaces?

8. Are there any upgrade costs or fees associated with ICD-10 compliance?

9. Will you allow our practice to run test claims using ICD-10 prior to the October 1, 2015 implementation date?

10. Can you migrate to ICD-10 prior to the implementation date?

If your vendor can’t answer these 10 simple questions about ICD-10, your practice should think about switching to Benchmark Systems.

the right payers. These systems should guide users to the correct ICD-10 codes and then automatically make conversions back to ICD-9 codes in the background for payers who have not made the transition.

Risk 3: Insufficient Training

Because ICD-10 is much more complex than ICD-9, it is important to train your staff on the new regulations and diagnosis codes as much and as often as possible before the cutover.

ICD-10 breaks diagnosis codes down to a much finer level than ICD-9. For example, there used to be one code of diabetes under ICD-9. Now there are over 50 codes associated with the disease. Learning how to navigate the ICD-10 codes may take time, but will pay off in the long run. If your practice does not train your staff as much as possible, it could become very costly in terms of cash flow.

One way to assist your staff in training is to utilize the training materials, webinars, and general information from your vendors.

Risk 4: Reduced Productivity

With a lack of in-house training and vendor and payer preparedness comes reduced productivity among your staff. This is something that no practice can afford.

But, you can increase your productivity level with a great EHR system. Your system should be sophisticated enough to use that it helps you narrow the list of applicable ICD-10 codes, but only when you need it. In this case, that would be when you are entering orders and selecting the diagnosis codes for billing.

It should also be set up to allow the user to utilize their existing knowledge of ICD-9 to lead them to the correct ICD-10 code. This minimized the impact on productivity while also assisting as a teaching mechanism during the transition to ICD-10, thus reducing training costs.

Figure 2: Top Concerns Associated with ICD-10 Transition

BENCHMARKSYSTEMS

Source: “ICD-10 Implementation Snapshot Study,” Aloft Group, February, 2013

Risk 5: Financial Risk Due to Cash Flow and Transition Costs

Fourty-one percent of providers cite financial resources as the biggest constraint on their ability to implement ICD-10. In addition to the possibility of cash flow problems after the transition, there are also costs to implement ICD-10 that your practice will have to take on.

In addition to a lack of vendor/payer preparedness, employee training costs and a period of reduced productivity, another aspect of the transition that may cost you are system upgrades. Ideally, your practice shouldn’t have to pay to upgrade your system to ICD-10. With a cloud-based system like Benchmark Systems’ Clinical EHR, the system is continuously upgraded at no cost to its users, and upgrades are rolled out as they’re required. If your system is not upgraded for free, your practice should consider switching to a new system or get ready to finance the upgrades that are coming.

© 2015 Benchmark Systems Rev.08/24/15

Poor Training Tools

0% 10% 20% 30% 40% 50%

Internal User Buy-In

Financial Resources

Outside Vendor Support

Internal Resistance

Other

47.7%

23.1%

41.7%

14.8%

20.8%

12.9%

How Ready is Your Practice?

Take a look at our ICD-10 Success Checklist to get a sense of where your practice stands in terms of ICD-10 Readiness. At Benchmark Systems, we are 100% prepared for the ICD-10 transition. Contact us today to learn more about our offerings.

Download our ICD-10 Checklist

© 2015 Benchmark Systems Rev. 08/24/15

Why Should You Rely onBenchmark’s Medical Billing Services

The Benchmark Medical BillingServices Include:

• Scheduling and eligibility checking module

• Entering of patient demographics

• Entering of all charges, payments and adjustments

• Reviewing and providing advice on coding structure from our certified coders

• Submission of electronic claims thorough our clearinghouse at no additional cost to your practice

• Resolution of all line item (procedure level) denials from patients and insurers

• Answering phone inquiries from your patients for billing related issues

• Generating patient statements at no additional cost to your practice

• Generating and mailing collection letters after reviewing the patient list with your practice

• Customizable solution based on your practice needs and work flow

“By utilizing Benchmark, we can rest assured that we can focus on our patients and not have to worry about the financial side of managing a busy practice.” Barbara Parks, MDFirst Health Medical Practice