Recipe for Disaster?
Recipe for disaster?
ICD-10 carries the ingredients for a perfect storm
Why wonâ€™t the reporting changes be a piece of cake?
Mike looked for Shannon as soon as he stepped in the door. The dinner service at the restaurant he owned had been busy and it was late, but his wife had been upset when he left, and he had a feeling sheâ€™d still be up, waiting to talk.
He was right. Shannon was staring blankly at the TV, but she brightened when she saw him.
â€œWant to talk?â€ he asked softly. He thought he saw unshed tears in her eyes. â€œCome on, honey, youâ€™re not getting weepy over a change in government regulations. There must be more going on.â€
Shannon rubbed her eyes. â€œMike, do you remember how excited we were when we both finally were our own bosses?â€
â€œOf course! I worked as manager at that steak house while you got your training –â€
â€œ– and then I worked at the hospital while you got the restaurant going –â€
â€œ– and then I opened the practice and we both were doing what we really cared about, and doing it the way we believed it should be done.â€
â€œThat hasnâ€™t changed.â€
â€œNot yet!â€ Shannonâ€™s smile faded. â€œBut Mike, I just canâ€™t see how Iâ€™m going to come up with the time or the money to meet the new insurance reporting requirements. The AMA is estimating that itâ€™ll cost small practices $83,000. I canâ€™t help thinking about how hard Iâ€™ve worked to build up my physical therapy practice, and I canâ€™t stand the thought that all that work could be for nothing.â€
â€œYou know what this makes me think of?â€ Mike asked, putting an arm around his wife. â€œCake.â€
Shannonâ€™s eyes grew large. â€œCake?â€
â€œRemember how, when I first opened the restaurant, I wanted to serve amazing, unique desserts, but I couldnâ€™t afford a pastry chef?â€
â€œI remember! You practiced baking cakes for weeks, getting everyone we knew to taste all the trials –â€
â€œ– and the errors!â€
â€œAnd finally you created the perfect cake.â€ Shannon frowned. â€œThatâ€™s nothing like my situation, though. I canâ€™t do trial and error. We have to be using the ICD-10 codes correctly as of October 1st, and thatâ€™s all there is to it.â€
â€œBut youâ€™re only remembering the cake, not my brilliant process,â€ Mike Â said playfully. â€œI identified the obstacles. In my case, those were things like how to make a really special cake without all the special training a pastry chef usually has.â€
Shannon perked up. â€œYouâ€™re right. I remember nowâ€¦ Well, in the case of the changes in reporting codes, the biggest issue is the sheer complexity of the new codes.â€
â€œI know you told me they have more digits than the old ICD-9 codes, and that can be an issue for software and filing.â€
â€œAbsolutely. The 7-place codes also allow a whole lot of new ones. ICD-9 has about 15,000 codes and ICD-10 has almost 70,000.â€
Shannon grew thoughtful for a moment. â€œI think my favorite is the new code for being struck or bit by a turtle.â€
â€œStruck or bit.â€ Mike made a thoughtful face, too. â€œWhy not one code for being bit and one for being struck?â€
â€œYou see what I mean, though.â€ Shannon began to show excitement. â€œItâ€™s not just one to one mapping of old codes to new ones. Itâ€™s the complexity of the new codes that makes it such a big deal. That and the urgency — on October 1st, the old codes just wonâ€™t work any more.â€
â€œSo itâ€™s a complicated system, and you have to get it right first crack out of the box on October 1st,â€ Mike summed up. â€œVery much like my cake situation.â€
Shannon laughed. â€œYouâ€™re goofy! But youâ€™re also right. Identifying the reasons that this is challenging does help. I think Iâ€™ll be able to sleep tonight after all.â€
Why wonâ€™t the reporting changes be a piece of cake?
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As a practice owner, I would ensure that I have a Practice Management Solution in place that is taking the time and revenue to upgrade and offer training time and materials to ensure the success of the practice.
Being prepared for ICD-10 is going to take more than trial and error or even timing. It’s going to take guided preparation and a level of mastery that most practice owners have only experienced when becoming clinicians.
I would team up with someone to help breakdown the steps to make the big change easier to handle.
Identify the challenges of ICD- 10 for the office and address them one by one instead of trying to solve all of them at one time.
The change to ICD-10 is a very complex issue, breaking down the codes a practice currently uses then compare to how the new codes will apply could be a great starting point.
Shannon’s dream was to become her own boss. She can keep living her dream, but with these new changes she is going to need help.
An added complication is that starting Oct.1, 2014 not all payers will implement ICD-10. Those that will accept ICD-10 could will deny claims with missing codes and those who still accept ICD-9 will continue to expect your claims in ICD-9 format. So your insurance claim submission software needs to be able to handle this added complexity of discriminating between payers who are ICD-10 compliant and those who are not.
Shannon was right to identify the reasons this will be challenging – now she needs to create a plan for this huge and complex transition. Having a software that provides webinars and support for ICD-10 is a must.