Chug, Chug… Here comes ICD-10. How will it affect Revenue Cycle Management and Receivables?

It’s a tough world out there for healthcare providers who are typically scrounging for 15-20% of their claims revenues which are either denied or incorrectly processed. ICD-10 is slowly approaching (10-1-2014), and with the number of codes jumping to 68,000 from the mere 14,000 of ICD-9, it made me wonder how much more difficult the billing and reconciling process may become for providers and patients as there are significant risks in this new process. Anne Smith, RN, principal and CEO of Fredrikson Healthcare Consulting, said, “while the biggest changes focus on code structure and conventions, it would be a mistake to assume only coders need training for the new system.“

An article written by Jim McLaughlin named “13 Tips to Ease the ICD-10 Switch” © Copyright ASC COMMUNICATIONS 2012. Of these 13, a few give hope that the transition won’t be as bad as some predict.

1. The transition doesn’t affect Current Procedural Terminology coding as physicians will still be able to use CPT coding for many of their procedures without any ICD-10-related changes.
2. ICD-10 places a much stronger emphasis on not only a broader range of conditions and procedures, but also on the severity, anatomic site, and cause of injury and disease, as well as the setting and approach to care.
3. There is still time! Providers should take advantage of the year and a half that remains before an ICD-10 mistake could cause a rejected claim and plan for the conversion via system upgrades, training and vendor fees.
4. Phase it in: Providers should divide the codes into groups of diagnoses and procedures performed most at their facilities, and select one group at a time to begin practicing in dual coding. Also try dual coding for a month or two in advance of the ICD-10 change.
5. Check with payers in advance. There will probably be unspecified codes remaining in ICD-10.

But then the negative thoughts enter the mind… these will scare you to death!

1. No program can automatically “crosswalk” or convert old ICD-9 codes into ICD-10 codes, because the newer system requires information not contained in ICD-9. While some codes can be directly translated, a single ICD-9 code could represent as many as 50 different procedures with separate codes in ICD-10, Ms. Smith said.
2. Save extra cash on hand. Even with extensive preparation, ICD-10 errors are likely to happen after Oct. 1, 2014. “No matter how prepared you are for ICD-10, whenever something new goes into effect, you’ve got to have [contingency plans] in place,” Ms. Von Eschen said. She recommends providers begin saving extra cash now to have enough on hand to absorb the cost of potentially rejected claims once they make the big switch next year.

In conclusion, within the billing process, the reconciliation of claims to EOB’s will have to be incredibly accurate! If not, that 15% unrecognized revenue could bump to a much higher number…