The Centers for Medicare & Medicaid Services insists it's not bluffing with the Oct. 1, 2014, switch from ICD-9 to the far more detailed ICD-10 coding system. Nonetheless, a large swath of medical providers remains woefully unprepared, a problem discussed last week at the American College of Physicians annual meeting, MedPage Today reported.
In particular, roughly 65 percent of physicians' clinical documentation doesn't contain enough information for coders to use for billing under the new system, Rhonda Buckholtz, vice president of ICD-10 education and training at AAPC, told attendees.
What's more, most payers said they won't reimburse for unspecified codes, she said, according to MedPage Today. "Under ICD-10, if we're not ready, we're not going to get paid."
Preparation tips provided by Buckholtz included the following:
- Work with health plans to make sure they have all the information they need to process ICD-10 claims.
- Test IT systems ahead of the switch.
- Train clinicians and employees on how they're going to have to do their jobs differently.
- Update forms and internal processes as needed.
But even if practices follow these steps to the letter, it's critical that they also begin saving cash now and create a "disaster plan" for the possibility of prolonged cash-flow issues, noted a post from Pediatric Inc. "I can't speak for other specialties, but in pediatrics, when we've gone through CPT updates and revisions, health insurance [companies] can take weeks, sometimes months before they update their systems despite being informed of the new codes months in advance," wrote practice administrator Brandon Betancourt, MBA.
"With ICD-10 we are talking about a complete overhaul of our entire CPT system," he added. "Can we be assured that [a] health insurance company will have all these codes ready in their system on day one?"
Within the post, Betancourt relayed advice from Pennsylvania pediatrician Dr. Susan Kressly emphasizing the urgency of building cash stores now, determining how much reserve your practice may need to run and preparing for the potential of zero cash flow during the transition.