Avoiding Top 5 Risks of ICD-10 Conversion

ICD-10 will be increasing the number of reporting codes from 13,600 to more than 69,000. This dramatic increase will create coding challenges for various medical practices, impacting their bottom line. Providers will have to make significant modifications in their procedures and systems to combat the risks associated with ICD-10 conversion.

In order to ensure a less expensive, hassle-free implementation, here are top five risks of ICD-10 conversion that practices will have to avoid:

1. Unprepared Payers

Many payers have started ICD-10 mapping which is the hardest facet of this transition. However, some payers are yet to ensure readiness for the new code set. Practices will have to monitor ICD-10 readiness for each payer to know which payer will receive which form of diagnosis code. This administrative challenge will cost time and money to practices

2. Reduced productivity of staff and physicians

Reduced productivity level of staff and physicians is something no practice can afford. Practices will have to hire experienced coders and billers to ensure error-free claims submission or else there is a risk of losing thousands of dollars in denials. Significant investment will be required in latest training tools and resources for the staff and the physicians  

 3. Financial Risks

It has been predicted by the CMS that ICD-10 conversion will increase denials by 100-200%, leading to revenue disruption caused by reimbursement delay. Execution of claim’s appeals will also add to the organizational costs. Experts have advised providers to keep approximately three months of cash reserves to mitigate cash flow glitches caused by ICD-10.

 4. Unprepared Billing, EHR and Practice Management Vendor

If billing, practice management and EHR vendors are unprepared for the transition, their clients (medical practices) will not get the required guidance and support. To minimize risks, practices need to ask for a detailed explanation from each vendor about how and when they plan on making system changes for implementation.

 5. Fraud and Abuse

Practices will have to avoid waiving co-pays once the new coding system is implemented. According to a Bloomberg Law article on ICD-10, the ‘pay and chase’ paradigm of fraud and abuse remediation is being abandoned by the CMS which means, practices will not be considered innocent if their claims are flagged as fraud. They will have to substantiate the claims in order to get quick payments.

Providers will either have to strengthen their practice financially or outsource billing needs to combat these risks and get timely payments.