ACA & ICD-10 Success… Make Your Own Luck.

By: Ray Jorgensen

Categories: Accounts Receivable, Billing, CHC, PMG Insights Blog

March 11, 2014

“Be prepared, work hard, and hope for a little luck. Recognize that the harder you work and the better prepared you are, the more luck you might have.”

-Ed Bradley, American Journalist

We have a saying at PMG… or at least we did in our early days… “We work without nets.” It is not an original line and actually credited in my life to a two-person construction crew we hired to build-out PMG’s third office. Even so, I must admit it seems to all too often describe my personal and professional life. I am not an advocate for being ill-prepared. In fact, I work hard, and have written before about how, to avoid procrastination in general and for ACA/ICD-10 specifically. However, as folks complained vociferously about the perils of the ACA… (as we fondly remember the government shutdown) and now folks are still pushing for a delay or cessation of ICD-10 implementation (http://medicaleconomics.modernmedicine.com/medical-economics/news/ama-calls-icd-10-delay) I feel compelled to offer some thoughts.

So with two months of the ACA’s initial impact behind us, how did you do?  Was there really an onslaught of new patients? Were your registration specialists truly overwhelmed with new enrollees? Was anyone’s worry and angst about the ACA’s impact worthwhile or helpful? Most CHCs we visit have seen little to no change to their business process. We are quite certain central billing offices, either housed at CHCs or their outsourced revenue cycle partners, will see more third party claims as a percentage of patients formerly uninsured now access local or national healthcare exchanges. Beyond this, not certain life at the majority of CHCs will be negatively impacted.

This “success” with the ACA roll out (while not entirely surprising) has created for some CHCs, a false sense of security around ICD-10. We have heard from more than a few CHCs something like “If ACA went well, why focus so much attention on ICD-10?” Simply stated, ICD-10 is an entirely different beast.

Here are several thoughts to ponder.

  1. The scope of the change is daunting (14,500 ICD-9 codes to more than 68,000 ICD-10 codes.
  2. Practice management (PM) and EMR systems MUST simultaneously maintain both ICD-9 and ICD-10 codes… perhaps indefinitely. Thus, your CHC must be on the most current PM/EMR offering.
  3. Your CHC must be able to bi-directionally cross-walk from one code set to the other; i.e., ICD-9 to ICD-10 and vice versa.
  4. Without thorough testing, your CHC won’t know the preparedness level of your business partners; i.e., payers, clearinghouse(s), and other vendors (don’t forget lab & imaging partners) with whom ICD exchange is commonplace.

Now, before panic sets in remember Ed Bradley’s quote above.

  1. Be prepared…
    1. Evaluate where ICD-10 impacts your organization and create a plan.
    2. Schedule training NOW for late spring and early summer… vacation may need to wait this year.
    3. Transition provider code selection to ICD-10 by mid-summer allowing your CHC billing team to cross-walk back to ICD-9… this is VERY doable and prepares your team well before the deadline.
  2. Work Hard…
    1. Don’t know many CHCs not already doing this as we see the skeleton staffing levels remaining after the 2007-2008 economic meltdown.
    2. Hold staff accountable for hitting preparedness deadlines. Like sticking with the exercise and diet before beach season… not easy but worth it when the plan comes together.
    3. Get ALL outstanding accounts receivable (AR) paid now BEFORE you have a huge volume of denials due to ICD-10. ALL low-hanging fruit must be gathered (collected) immediately. Moving a CHC to 30 days of AR (DAR) is VERY achievable.
  3. Be Lucky…
    1. As stated… the harder you work, the luckier you are.
    2. Nuff said on that.

Remember, your CHC does not need to be expert at ICD-10 by October 1 but you do need:

  1. To know what risk areas exist… and be prepared for as many as able.
    1. Non-payment… clear your credit line and/or know how to access to 3-6 months of expenses.
    2. Crosswalk not easy… have general equivalency mapping software
  2. To have a training plan… and be certain it is fulfilled with period evaluation.
    1. ICD-10 chart audits… 10 notes per provider?
    2. Staff testing around ICD-10 rules and nomenclature… who gets it and who needs help?
  3. To understand obstacles will arise… and know how to rectify.
    1. Clearinghouse failure… who is back up??
    2. Payer not paying… who is lead contact at top payers?
    3. PM/EMR not functioning as expected… invoice to vendor paid up?? Lead contact who returns your calls promptly??

“Worrying is like paying interest on a debt you may never owe.” This is one of my favorite Mark Twain quotes. Worrying is simply useless.

Be prepared.                     

Work Hard.

As a result of these two efforts, your CHC will be successful as a result of having made your own luck. The evolving healthcare system brings constant change. ACA implementation and ICD-10 are the flavor of the day.  Prepare and work hard today to guarantee for tomorrow your CHC’s optimal performance.