What are the top 5 ICD-10 risks to prepare for?

Many eligible providers and hospitals have experienced difficulty training and educating their practices on the new codes and procedures that come with the conversion from ICD-9 to ICD-10. Some blame it on a lack of useful resources, and others simply predict another delay. 

Although some practices and health care organizations feel that another ICD-10 postponement would provide some relief as they scramble to prepare for new documentation processes and other changes, many organizations believe that another delay would only be a setback for the industry. For example, Congress recently made it clear that it supported the Oct. 1, 2015, implementation date and assured providers that they would not see another delay.

What effects would another delay have?
The Healthcare Information and Management Systems Society pointed out that one of the reasons the health care industry is making the transition from ICD-9 to ICD-10 is for the well-being of patients. A new set of codes may take a great deal of time and energy for providers to become familiar with, but an updated system means that patient diseases and illnesses will be more thoroughly defined. This would ultimately allow for more individualized patient care.

Enhanced documentation and administrative procedures will improve patient care and quality. Better tracking and monitoring of disease processes for global comparisons will ultimately lead to more effective prevention strategies as well as improved care delivery.  

The old codes used in ICD-9 do not support new procedures and best practices. Since its implementation in 1979, there have been no upgrades to the system. There is no space to accommodate new sections of codes while maintaining the system's general format with logical, categorical sets of procedures and diseases. Codes that are over 30 years old become incredibly difficult to find because a good number of codes are put wherever there is room in the sequencing, according to the HIMSS. An upgraded classification system would enable codes to cater to advancements in medicine and medical procedures.

Many providers and hospitals have worked hard to prepare for the transition. Money and time have been spent on training sessions to educate practices on the new codes. If another delay were to occur, it would cause problems for these physicians, who would have to revert back to the old coding system.

What should providers prepare for as they transition?
There are a few potential risks that experts urge providers to prepare for as they make the switch to ICD-10. Here are five.

1. The first risk is a lack of preparation by payers. According to AthenaHealth, a survey of payers conducted in 2012 showed that 39 percent reported that they were not likely to be prepared for the ICD-10 transition. Practices will need to monitor how prepared each payer is for ICD-10, so that they are aware of which payer needs to receive which form of diagnosis code.

2. Another potential issue that physicians may see after October is that their staff was not properly trained. The more familiar each member of a practice is with the new, far more complex coding system, the less painful and costly the switch to ICD-10 will be. Many experts suggest that providers train their staff by practicing with the new system every day until the actual implementation date. Although classroom sessions can be effective, nothing will better prepare a practice than actually using the application to see how it fits with the day-to-day workflow. This will help pinpoint troubleshooting problems before the official conversion has even taken place. 

3. Some providers may find that there is a lack of management to control the different changes and difficulties that practices are likely to run into as they transition. A key to a successful conversion is establishing a project manager to take the reigns with all of the areas impacted by the switch to the new coding system. These areas include revenue cycle, patient access, patient care and physician documentation. 

4. Reduced staff workflow is something that no practice can afford. One of the easiest ways to avoid this is with an electronic health record system that was designed to make documentation processes simpler, which is specifically important during the transition. An efficient EHR system that was designed to enhance patient care and workflow will ultimately reduce the impact the ICD-10 conversion will have on a practice. 

5. Practices should be prepared for a delay in their ability to pay their bills. Providers are probably going to make a few mistakes during the first couple of months of adapting to ICD-10, which in turn will cause delays in getting their bills out in a timely manner. According to Healthcare Finance, most accounts receivable departments generally take anywhere from 45 to 55 days to process everything. The ICD-10 transition could tack on another 20 days. Preparing for a delayed cash flow with cash reserves will help avoid serious problems.