'Final' ICD-10 date to heat things up
Even before the Department of Health and Human Services posted the final rule declaring Oct. 1, 2015 as the compliance deadline, industry analysts were convinced that it would be a hard-fast date.
"Yes," is what CTG Health Solutions consultant Cecil Bohannon said when asked if this would be the true launch date after several delays.
"The issue is more about the delays than the codes," said Bohannon, healthcare IT and operations consultant for Buffalo, N.Y.-based CTG. "Most of the big and mid-sized providers are ready and the impact on the smaller providers won't be as negative as they think. The delay muddied the waters."
Coming from the payer environment at Blue Cross of North Carolina, Bohannon provided comments on the original ICD-10 proposal nine years ago.
"It seemed like a good idea at the time – there was hope from the payer side that it would result in better data that was actionable and would result in operational efficiencies from a medical record perspective." he said.
Payers were also hopeful that ICD-10 would generate information that would be put into a list of coverages so it could be published and "providers could see with a better degree of transparency what was covered and what was not," he added.
When the ICD-10 rule came out four years ago, Bohannon says payers were excited about a new healthcare climate and new approaches for relationships with providers. What he didn't expect was a lack of enthusiasm from providers.
"It was amazing to me how little had changed in the provider environment compared to what was happening with payers," he said.
Bringing in docs
While hospitals and health systems worked feverishly to make the October 2014 deadline, many physician clinics did not feel the same sense of urgency, says Tom Giannulli, MD, chief medical information officer for Irvine, Calif.-based Kareo. The extra year, he says, only solidifies the sense that there is still plenty of time to get ready.
"ICD-10 is still in the back recesses of physicians' minds right now," Giannulli said. "No one is making bold moves now, but it should heat up next year and will become a key topic of conversation next year."
Physician reticence most likely has several driving factors behind it, but Giannulli pointed to a Medical Group Management Association study that showed 90 percent of physician practices were "uncomfortable and concerned" about ICD-10 clinical productivity coding. Some practices have forged ahead with ICD-10 adoption and as a result will be "ahead of the curve" by the deadline next year and that those who did nothing "probably fared better, but they will have to do it eventually."
Giannulli believes that if CMS provided more guidance on the ICD-10 initiative, the whole process would go more smoothly – especially for physicians. Ideally, he says there would be an implementation in three phases – an ICD-10 test day early in the year, a verification day a couple months before the deadline and the "go live" date on Oct. 1.
"If they did this, people would understand what's coming and there would be less stress and anguish," he said.
If survey data from Brown-Wilson's Black Book Rankings is any indication, professional RCM (revenue cycle management) companies stand to gain a lot of business from physicians for ICD-10 coding.
The Black Book Rankings surveyed 21,079 qualified users between November 2013 and April 2014. The survey asked participants about their medical practice operational priorities over the next few years, and nearly 90 percent of solo and small practice physicians with in-house billers and collectors said they expect to outsource most or all their billing functions over the next 24 months.
Giannulli sees this as a key trend.
"I believe we will see this," he said." The majority of clinics favor outsourced billing for their practices because of the complexities with the new codes and time -consuming work involved with it. If you use an RCM contractor you can save money and assign those dollars to care coordination."
David Winn, MD, CEO of Austin, Texas-based e-MDs agrees that a vast majority of physician clinics will rely on RCMs to handle billing under the new format.
Among the advantages of using a professional RCM company, he says, is that if there is a question as to the correct code, coders can enter ICD-10 descriptions associated with the diagnosis and send to the physician for clarification. The physician receives a URL with the intermediate search state, and once clicked, will provide an immediately scoped set of keywords for selection, quickly resulting in a final code.
"ICD-10 is far more complex than ICD-9 and physicians will need experienced coders," Winn said. "In turn, they will need more powerful new search tools in order to code correctly. With the proper tools, outsourced billing will go more smoothly."