ICD-10…We Don’t Need No Stinking ICD-10

In my daily review of my medical practice list group a member posted an announcement that CMS was considering delaying the implementation of the ICD-10. Medical Practice Managers have been told for over 2 years that the date of Oct. 2013 is in concrete, will not be moved, be ready or else. Well, it seems that the implementation of moving to the ICD-10 is not really working as well as planned. As of Jan. of this year all medical offices needed to switch from billing under the ICD-9, which is called 4010 to billing under a new system, 5010, which will allow providers to bill using the ICD-10 identifications.

I personally oversaw the billing transition from the old system (4010) to the new system (5010) and it was an unmitigated disaster. Our software company was not ready for the transition and we suffered a two to three month loss of monies due to software issues (and the physicians were none too happy). I attended a seminar at the beginning of this year discussing the 5010 problems and was given a handout from CMS which outlines how to get ready for the 5010 transition. These are the recommendations:

How to Ensure a Smooth Transition to Version 5010 Below is an overview of steps providers can take to maintain continuity of operations for their practices as they prepare to complete Version 5010 testing and implementation by the January 1 deadline:

• Be sure to have a transition plan in place. The plan should document the steps that will be followed and the dates that milestones will be achieved to comply with Version 5010 requirements. Make your plan available to payers and other business partners so that testing can be scheduled.

• Communicate with vendors regularly; encourage them to take action now to avoid problems with reimbursements. Providers should identify areas within their practice that depend on vendor support and communicate with their vendors immediately to ensure their systems will be up-to-date. Hold vendors accountable by discussing business requirements to ensure products are Version 5010 compliant. Ask vendors about the new Version 5010 features and request trainings to make sure internal staff is comfortable using the updated system. Lastly, talk to vendors about any contract upgrades or costs involved with implementing the new software.

• Reach out to a clearinghouse for assistance. A clearinghouse ensures that claims smoothly transition between practices and payers. When providers submit noncompliant claims, the clearinghouse translates the claims into a compliant format and sends the compliant transactions to payers. The clearinghouse serves as a translator from the Version 4010/4010A to 5010 format. Even if you normally submit your claims to your business partners directly, a clearinghouse can bridge the gap if you are behind in implementing Version 5010, and maintain the submission and processing of your claims while you complete your transition.

• Establish a line of credit. Providers should work with their financial team to establish or increase a line of credit to cover potential cash flow disruptions. A line of credit will help a provider’s practice prepare for potential delays and denials in payer claims reimbursements due to noncompliant Version 5010 transactions being submitted. A practice should also evaluate its cash reserves.

• Take advantage of the free software available to Medicare Fee-for-Service (FFS) providers via Medicare Administrative Contractors (MACs). Providers should contact their MAC for more information.

Take note of recommendation number 4, establish a line of credit. Physicians cannot afford a two to three month break in their revenue due to the incompetency’s of the federal government. Our office did have a line of credit which got us through the drought; however, not all physicians have the collateral to establish a line of credit to cover three months of anticipated revenue. “The Medical Group Management Association recently sent a letter to Department of Health and Human Service Secretary Kathleen Sebelius, saying that if the government does not rectify the current problems with the transition to HIPAA Version 5010 electronic transaction standards, physician practices may face "significant cash flow disruptions, operational difficulties…or even the prospect of closing their practices."

So now the federal government is back peddling so fast they are going to get whiplash. “CMS Acting Administrator Marilyn Tavenner said the agency plans to “re-examine the pace” of implementing ICD-10, marking the first public indication that the 2013 implementation date is not as firm as CMS has repeatedly said it is.”

As I have stated before, the only reason for going to ICD-10 is because the rest of the world is on ICD-10 and we need to be like the rest of the world. So I state again, the rest of the world is also metric, but I don’t see America jumping on the metric bandwagon.