ICD-10 Transition Advice: Do Not Panic!

If you work in the health care world and are looking for an uninteresting, uneventful 2014, now may be a good time to change careers.

Don’t get me wrong. I have never been one to be an alarmist, and I do see a bright future for our business. But the turmoil we have seen in the past few years is probably going to seem tame compared to what’s coming in 2014.

One thing that may surprise you is the idea that health care reform is one, but isn’t the primary reason that 2014 promises to be an interesting year. It’s actually the transition from ICD-9 to ICD-10, which is scheduled for Oct. 1, 2014.

I once worked with a veteran coder who vowed to coincide her retirement with the transition from ICD-9 to ICD-10. I’m not sure if she retired or not, but that may have been a bit of an extreme stance to take. Make no mistake; the transition from ICD-9 to ICD-10 is a big deal.

The code set is moving from about 14,000 diagnosis codes to 68,000. But before you start planning your retirement or go to other extreme measures, like selling your practice, consider this: Most of the heavy lifting will be done on the front end through your Electronic Health Record (EHR) and/or your practice management system. In addition, the claims clearinghouses that are the difference between getting paid and not getting paid for services will be under the gun.

That doesn’t mean health care practices and organizations are off the hook. On the contrary, the upcoming transition will mean that it is more important than ever to have a handle on the operations and revenue cycle of your organization.

Here are some of the key questions that are important to answer going into this transition:

• What are you currently getting paid for the various goods and services you provide?

• Are you optimizing the revenue under the current coding system?

• What kind of measurement and reporting do we have in place to monitor your revenue streams?

• What processes to you have in place to identify and intervene on changes to reimbursement at the encounter level?

• If you rely on paper or manual coding processes, what needs to be done to crosswalk those tools?

• How does the new coding system affect your pre-access or pre-authorization processes?

• What is your overall plan for implementation?

• What is your contingency plan for delays or loss of revenue?

These are not easy questions to answer. What makes them even more difficult to tackle are the other issues that will be going on simultaneously. Many practices are still dealing with transition issues to new EHR and/or practice management systems. Others are looking to move to Phase II of meeting Meaningful Use requirements. Continued scrutiny on reimbursement levels and third-party reimbursement requirements will be another complicating factor. And health care reform will have impacts in both the short- and long-term.

The bottom line is this: Now is not the time to panic. Now is the time to hunker down and make sure your organization is running at optimal levels. Working with an experienced health care advisor can help in many ways that offer both short- and long-term benefits.

While I firmly believe it is NOT the time to sell your practice or think about early retirement, I also contend that it is also NOT the time to sit back and do nothing.

Brian Bourke, MBA, is manager of health care consulting at Honkamp Krueger & Co., a Top 100 CPA firm (headquartered in Dubuque, Iowa) with offices Cedar Rapids, Clinton and Davenport, Iowa and Madison and Platteville, Wisconsin. To contact Brian for more information about Honkamp Krueger services please email him at bbourke@honkamp.com or call 563-242-6911.

Honkamp Krueger & Co., is a proud member of the National CPA Health Care Advisors Association (HCAA). HCAA is a nationwide network of CPA firms devoted to serving the health care industry. Members provide proactive solutions to the accounting needs of physicians and physician groups. For more information, contact HCAA at info@HCAA.com.