THE DIGITAL PRACTICE

You’re still not ready for ICD-10?

No worries, Dr. Procrastinator: Here are some last-minute hacks.

By Peter J Polack, MD, FACS

Ophthalmology practices have known for a long time that ICD-10 was en route. And while CMS has granted a grace period (more on that below), the procrastination period is over. Serious financial consequences await those who ignore this warning.

Tony Onorad of ICD10Coach.com describes four risks related to the ICD-10 transition and the “hacks,” or responses, to mitigate them.

MISUNDERSTANDING THE GRACE PERIOD

“Many practices think they have another year to ‘code unspecified,’” Onorad says. “This is FALSE!” The grace period only pertains to CMS transactions, not private carriers, so you still need to know which ICD-10 family to code within. Delaying the transition will hurt your practice when value-based reimbursement (VBR) begins rewarding those who are prepared.

Hack. Crash-course coding. Get familiar with the top 20 to 25 codes for your specialty. Free resources are available, such as the Ready10 ICD-10 Translator and the GEMS conversion tool on the CMS site.

CLAIMS DENIALS

CMS predicts a 100% increase in denials and a 40% delay in accounts receivable. This will impact your cash flow, so you’ll need to have a plan in place.

Hack. Denials management. If you are using an EMR system, you should know its readiness. ICD10 Coach has a complimentary EHR Vendor Checklist that lists the questions you should ask. Many EMR systems have a coding engine so you can start dual-coding encounters for your practice. Mr. Onorad says that 90% of denials are preventable and more than 60% are recoverable.

FINANCIAL HARDSHIP

Due to delays in workflow and a practice’s revenue stream, CMS forecasts that the typical practice will have a 20% to 40% drop in productivity.

Hack. Reserve capital. CMS is advising providers to have six months of cash reserves to deal with any possible effects on cash flow. Talk to your bank representative to determine your available liquidity and operating capital reserves.

MISSING OUT ON VBR

According to the Department of Health and Human Services, 30% of Medicare fee-for-service reimbursement will convert to a value-based performance model by the end of 2016. Primary care is well on its way with other specialties to follow. A hallmark of VBR is interoperability, and the goal is to have practitioners share information using real-time software that can fetch, analyze and report data. These so-called business intelligence tools can help with the bottom line.

Hack. Get educated on VBR, and stay ahead of the curve. VBR is reliant on correct ICD-10 coding, so make sure your ducks are aligned.

CONCLUSION

Mr. Onorad cautions practices not to despair. “You’re not alone. Many don’t know where to begin.”

But, he says, CMS has resources on its website, so take advantage of them to learn how you will be affected. You have to begin somewhere.

For those practices who want more help (and fast), ICD10 Coach has a free webinar at http://bit.ly/1kFzP0E. OM

Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multi-subspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice resource for physicians and administrators. His email is ppolack@ocalaeye.com