Although many reports published estimate the cost of implementing the ICD-10 transition, a preliminary estimate by Price Waterhouse Coopers puts the nationwide estimate at $8 billion. The implementation will cost the Medicare program something in the range of $200-$220 million. According to a survey done by The Medical Group Management Association, the implementation is will cost $84,000 for small practice physicians, while large practices could be facing a price tag of up to $3 million. For health plans, depending on their size, it is likely to cost anything in the range of half million dollars to $14 million for the implementation.
A smooth transition before the compliance date of October 1, 2013 would certainly require a well planned and managed implementation process to be adopted by the providers. Experience from other countries has shown that organizations that start early in terms of preparing for the transition, including budgeting, implementing and training costs, save a considerable amount on their investments. It is vital for the successful implementation of ICD-10 is analyzing the use of ICD-9 to evaluate the areas in which ICD-10 will have the biggest impact. Not only would this provide the organizations information about the magnitude of the implementation, they would also be able to understand the benefits (improved quality of patient care, coding process, reimbursement process, productivity, resource management, etc) associated with the implementation.
Budgeting for time, training, IT, equipment and resources should begin as early as possible to prevent any financial disaster. The increased specificity of ICD-10 codes is certain to bring some form of contract re-negotiation. Therefore, this factor needs to be taken into account. To ensure successful implementation of ICD-10, a phased approach should be followed by the organizations, which should include:
• Planning the implementation, along with the impact assessment
• Preparing for the implementation (training, resources, IT, etc.)
• Go live preparation
• Post implementation follow-up
Preparing Audits for ICD-10 Implementation
Preparing for ICD-10 audits can be a complex process that requires sufficient planning and analysis. Some of the steps that you will need to take to prepare a successful audit for your ICD-10 implementation include:
• Sampling: Create charts for your most frequently used diagnoses. Many software programs have the ability to pull the list of visits based on diagnosis. This information can be really helpful in preparing the charts.
• Prepare spreadsheet: Create a spreadsheet that has columns for date of service, ICD-9, ICD-10, checkboxes for supported and non-supported and a column for comments.
• Mapping software: If you do not have mapping software, you could consider an ICD-10 mappings book. Some of the common mapping software programs are GEMS, Encode Pro and Code It Rite, among others.
• Analyze sampling information: Go through each chart and see the ICD-9 code for that chart. Now, use the mapping software and see what the ICD-10 code would be for the same and whether it is supported by documentation.
• Provide evidence for improvement: With each finding, keep on adding data to the spreadsheet created in Step 2. This spreadsheet would ensure that the provider always selects the correct diagnosis codes. Although this information would have been available to the provider before, following a systematic approach will enhance his awareness and clarity about the same. By the end of the audit, providers would have all the necessary information relating to diagnoses, their respective ICD-9 and ICD-10 codes, as well as an understanding of the practical issues they are going to face in ICD-10 implementation. This information can be extremely useful for providers, since it can help them set up goals for improvements towards the ICD-10 implementation.
Experts believe that performing at least 3 audits before the actual ICD-10 implementation could prevent most complexities that could arise during implementation, while reducing costs.