How will ICD-10 Impact Physician Practices?

May 16, 2013

We’ve all been warned over and over again that ICD-10 implementation will have a significant impact on technology systems and that the cost and risk of information system replacement or upgrades could prove exorbitant. When you take a step back and settle into the ICD-10 reality, do you ever think “how will ICD-10 impact physician practices?” Naturally, most people think, “My practice has already developed a budget for this, we are all set”. Or are you?

The ICD-10 transition represents much more than just an IT issue; providers must prepare themselves for the possibility of an ongoing strain on their wallet! It has been estimated that practices should plan to keep at least a 3 to 6 month financial reserve to get them over the transitional hump.

What Hump?

The greatest financial and operational burdens from ICD-10 implementation will be experienced by physician practices. This impact will likely be due to an increased number of claim denials as a result of a poor understanding of new code sets and coding requirements. Even though professional services are paid based on the procedure code, don’t forget, the diagnosis code is what is needed to support medical necessity.

So, What does this really mean?

While a patient’s condition may be covered today with ICD-9 codes to support medical necessity, the condition might not be covered with ICD-10. This translates into lost revenue, and is not the only thing that will impact your wallet! Most physician practices do not employ coders; typically, administrative staff and physicians are responsible for ICD code assignment, potentially increasing the risk of coding errors and, you guessed it, denials.

One of the best ways to avoid increased denials and the strain on your bottom line is PREPARATION!  Preparation is vital to a successful transition from ICD-9 to ICD-10.

For more information on how to prepare, read our 8 simple steps to prepare for ICD-10

Paula Banicki
Billing Coordinator, MBA HealthGroup