Practice management consultant shares 8 steps for physicians to take now
An experienced practice management consultant best described the looming ICD-10 conversion “as though 19 percent of the GDP will be required to start speaking French to each other … and if grammar, pronunciation and punctuation aren’t perfect, no money will move.”The “frighteningly large change” coming Oct. 1 has caught many physician practices off guard, said Jennifer O’Brien, MSOD, a practice management consultant with KarenZupko & Associates Inc. “We’re finding that some practices have done absolutely nothing to prepare.”According to the latest Workgroup for Electronic Data Interchange (WEDI) ICD-10 readiness survey results, representing a mix of practices and hospitals, “it’s clear the industry continues to make slow progress, but not the amount of progress that’s needed for a smooth transition.” Only one in three practices were conversion-ready, with the remainder citing significant obstacles to progress: competing priorities and other regulatory mandates. “All industry segments,” the report concludes, “haven’t gained sufficient ground to remove concern over meeting the Oct. 1 compliance deadline.”“Apparently, there’s still a lot of hope on the part of providers that it’ll be postponed again,” said O’Brien. (The ICD-10 conversion was originally slated for Oct. 1, 2013. In 2012, an extension was announced.) “Because of the healthcare.gov debacle, people are thinking that CMS will postpone it again. The experts are saying another postponement is highly unlikely.”Noting that “denial is only going to make it more painful,” O’Brien recommended eight steps for every physician provider to take in early 2014.Physician providers in a practice that allows them to control their own salary or draw should reduce that amount by 25 percent now. “Don’t pay out the rest,” she said. “You’ll likely need it to pay yourself during the fourth quarter (Q4).” By planning for little to no Q4 revenue while also reducing the draw in the first three quarters of 2014, “you can pay yourself in Q4.” O’Brien explained: “Because the entire industry will make a change of such magnitude on the first day of Q4, the revenue cycle is going to be disrupted. Either the practice is going to make mistakes coding, payors are going to have difficulty processing the claims, or both. For practices that don’t adequately prepare, Q4 could be bone dry.” By comparison, Canadian physicians reported a productivity reduction of up to 50 percent during their conversion.Secure a substantial Line of Credit (LOC) with a bank to cover payroll and operating expenses in Q4. “Like an insurance policy,” she pointed out, “a LOC must be secured before needed.” Scale back in 2014. “This isn’t the year for capital expenditures, other purchasing and hiring that’s not absolutely necessary,” she said, noting the strategy applies to personal expenditures also. “2014 isn’t the year for physicians to build that dream vacation home.” Because of increased expenses and decreased productivity, let employees know now that year-end bonuses are highly unlikely. “It’ll be a belt tightening year,” she said. Order ICD-10-CM books, software or apps. “Physician practices don’t need ICD-10-PCS, just ICD-10-CM,” she said, noting that CPT will continue to be used to report procedures and services for physicians; ICD-10-PCS is the book hospitals use to report services and procedures. (See “Quick Definitions.”)Depending on the practice, run a frequency report of the top 25 to 75 most commonly used ICD-9 codes with nomenclature. “For specialty and subspecialty practices, the most common 25 diagnosis codes should be sufficient, but for internal medicine, emergency medicine, and other practices with a broader scope, there will likely be more than 25,” cautioned O’Brien. “Once you have the list of your most commonly used ICD-9-CM codes, use your new ICD-10-CM books to crosswalk them to correct, complete ICD-10-CM codes. Don’t leave this up to the office staff. Do it on your own or with your staff. The process of converting your most commonly used diagnoses to ICD-10-CM will likely demonstrate a need for you to change your documentation of diagnoses and may show a one-to-many crosswalk. That is, what used to be covered with one code will now require additional information to select the correct code from a list of many.”Don’t plan on leaving the conversion up to internal billing staff or an external billing service. “When asked, ‘What are you doing to prepare for ICD-10-CM?’ we’ve had physicians and managers respond, ‘Our billing service is going to take care of that.’ Guaranteed disaster! ICD-10-CM requires significant, documented input and details from the clinician for accurate, complete codes. There’s no billing service or even computer program that can crosswalk ICD-9-CM codes to ICD-10-CM codes without additional details and input from the clinician.”Research available ICD-10-CM training. “Many national specialty societies, hospitals and practice management software companies and other organizations are offering ICD-10-CM training for physicians and their staff,” said O’Brien. “If your practice is large enough, it may be cost effective to hire the ICD-10-CM trainer to come to you and your staff. Plan to spend the next several months learning the ICD-10-CM coding system and changing your documentation. Don’t think you can cram for this by going to one or two seminars in the summer. This is like board examinations; only in this case, if you don’t study, prepare and perfect well in advance, the failure could mean financial ruin.”
Quick DefinitionsICD-10-CM: The clinical modification of the World Health Organization’s ICD-10, which consists of a diagnostics classification system. In the United States, ICD-10-CM includes the level of detail needed for morbidity classification and diagnostics specificity and provides code titles and language that complement accepted clinical practice. The system consists of more than 68,000 diagnosis codes.ICD-10-PCS: Developed to capture procedure codes, this procedure coding system of 87,000 procedure codes is much more detailed and specific than the short volume of procedure codes included in ICD-9-CM.