ICD-10: An Administrator’s Perspective

By: Jason Lott
Friday, May 2, 2014

By now, you have heard of ICD-10 and know it is coming. You know it will affect not only your practice but our overall healthcare delivery system, too. Within this final period of preparations, I have had the opportunity to attend several ICD-10 seminars and training sessions geared toward preparing practices for implementation. With this article, I would like to explore ICD-10 from a practice administrator perspective and take a look at specific focus areas.

In one of the ICD-10 seminars I attended this past year, I was challenged to view the oncoming implementation and execution of ICD-10 in a way similar to preparing for a hurricane. Unlike other natural disasters, such as earthquakes, tornadoes or flash floods, you can see a hurricane coming — and you must make some decisions if you are in the path of the storm. As the projected path of the hurricane is determined, you must decide whether you will be directly hit, potentially causing substantial damage, or will experience lesser storm surges with heavy rain. Whatever your preparation level or assessment of potential effects on your practice, ICD-10 is coming and stands to be one of the biggest changes in health care in 30 years.

By this time, physician practice administrators and managers should have already employed several different strategies to prepare for this upcoming transition to ICD-10, beginning their “hurricane preparedness.” Without belaboring the history of ICD-10 and why it is being implemented, the time for a physician’s practice to prepare is here and now. Undeniably, a laundry list of tasks related to preparedness exists.

One of the most significant aspects of any ICD-10 training seminar typically involves discussion surrounding payer testing on claim submission. Basically, this is the trial-and-error testing that must be done prior to the implementation date to ensure consistent claim processing. It allows identification of slow-pay and no-pay issues at a time when claims can still be processed through current methodologies. Through this very important process, practices will be able to see and determine which insurance companies will be able to process their ICD-10-based claims effectively.

From a practice administrator’s or manager’s perspective, this is no small feat. This comprehensive project includes coordinating with applicable internal billers, coders, follow-up personnel and associated parties to map out insurance companies to target, etc. From an external perspective, payer testing involves communication, correspondence and direct insurance company follow-up by administrators and managers. When done effectively, this process is all-encompassing and involves an ongoing set of tweaks and adjustments.

This integral piece of preparedness directly relates to one of the most significant concerns on practice administrators’ and managers’ minds regarding ICD-10 implementation — cash flow. The looming reality is that a failure to adequately prepare can directly result in slow-pay and no-pay issues, while the burdens of payroll, rent expenses and other overhead will stay consistent or increase. Practice administrators and managers will be the captains, in many instances wrangling all aspects of ICD-10 implementation within physician practices, and maintaining specific focus will be essential.

In summary, the time to prepare for ICD-10 is now. The president recently signed into law an extension of the ICD-10 effective date to next year. What will your practice do? There has been no downgrade of the storm, just a longer wait for landfall. Use the additional time to effectively prepare for a successful implementation as we adapt to our ever-changing healthcare environment.

Jason K. Lott

Jason Lott, President of the San Antonio Medical Group Management Association (SAMGMA), is also Director of Business Development and Practice Management at IPC: The Hospitalist Company. He can be reached at 210-344-7287 or jlott@ipcm.com.