What’s Next After Surviving The ICD-10 Launch?

Wow, October 1, 2015 felt like Y2K all over again. Like January 1, 2000, the day seemed to proceed far more normally than expected. I kind of thought the computers would crash and we would not be able to do anything.

After years of hearing about ICD-10 and the repetitive delays of implementing it, I seriously doubted if it would ever go into effect. Personally, I did something that I would normally not do … I procrastinated. I had no faith that ICD-10 conversion would actually happen and did not want to waste my time and energy learning a system that I would never need. I know many organizations and billing experts said it was coming, but we have heard stuff like that before.

A year ago, one of our bright young associates returned from an American Podiatric Medical Association (APMA) Young Members meeting all freaked out about ICD-10. Whoever was lecturing had scared those young practitioners with the doom and gloom of the new coding standard. She came back in a panic and came to me for advice and counsel. I did something I never did before with her: I shrugged my shoulders. I had no knowledge and no plan. I told her we would figure it out if it happened.

I ignored the hospital seminars, the online seminars and all other opportunities to get ready for ICD-10.

Well, as spring turned into summer, it became inevitable that ICD-10 was going to happen. We had to put a plan in place and move quickly. Fortunately, we had several things in our favor. We have been using electronic health records (EHR) for many years and our current system, eClinicalWorks, had prepared for an ICD-9 to ICD-10 converter. I know all EHR companies offer that but I was confident that eClinicalWorks, which offers one of the largest non-hospital based EHR platforms (only EPIC is larger), would be on top of the conversion. Additionally, we have an incredible and experienced management team including a sophisticated billing department, who were able to start to understand and create the systems necessary to navigate the transition successfully. Twenty-five of our doctors attended an all doctors meeting we had that involved live demonstrations and worksheets on how to work with ICD-10.

One of the greatest sources of information for me were members of Foot and Ankle Business Innovations (FABI) Mastermind program, who used the Facebook Forum to discuss the trials and tribulations of the transition. One member, James Anderson, DPM, of the St. Louis area, brought an even better eClinicalWorks product to the discussion. This product served as a crosswalk between ICD-9 and ICD-10, and proved to be a big help to us.

As we continued to get closer, that young associate who I mentioned earlier started getting more nervous about the transition. She purchased the ICD-10-CM book and read the whole thing. It is more than two inches thick of small print. As she started investigating the crosswalks, lectures she had been to on the subject and conversations with the so-called gurus of podiatric billing, she started doubting whether all of those programs and people had it right after all. She wondered if we were being misguided to our own demise.

Under her direction, we started investigating and reading deeper into it. As we get deeper into it, I can tell you that I am just not sure. One paragraph tells you to do one thing but then the following paragraph contradicts it.

What is the rub here? I am seriously concerned about payment. Giving insurance companies any opportunity not to pay is like leaving a bunch of kids alone in a candy store. There are so many variables to the payment of claims. Did you code it correctly? Did you provide appropriate documentation to each code? Did you link the codes correctly with the CPT? Is the insurance company able to properly handle ICD-10 claims? The insurance companies are as much in the dark as we are.

When this all comes down, I am afraid the insurance companies are just going to deny claims and delay payments. It would not be unprecedented. They hold their millions for 60, 90, even 120 days and that turns into a lot of money in interest for them. Insurance companies do not get hurt (even though they will cry on MSNBC and the business sections of newspapers). Patients will not get hurt. They will not have to pay their copays and deductibles for longer. We get hurt. We still have to pay rent, salaries, etc., even if the payments from insurance do not come in.

We have methods in place to figure out if insurance companies are processing our claims. We are using our relationships within the insurance companies to find out whether our claims are good or not, and how we need to improve them to get them paid. We are being proactive and not waiting the 30 to 60 days to find out that what we are doing is wrong and will negatively impact cash flow for the rest of the year. Our initial communications with our major payors has been surprisingly positive. We have already received a substantial amount of our first week claims as of October 12. That being said, I am cautiously optimistic.

If it is Y2K all over again and all the fuss was for nothing, then we will be ready to hit 2016 with added optimism. I have heard stories of how older practitioners and single- or two-person practices of all types of specialties cannot handle the transition to ICD-10 and are quitting practice. I am sure there are plenty in our profession thinking the same way. However, there are a lot of people who are still excited about practice and using things like this as an opportunity to thrive, not just survive.

On October 28, Foot and Ankle Business Innovations FABI is hosting a free live webinar to discuss ways to prepare your practice for 2016 and set it up for success in the future. If you are interested in hearing like-minded people who love the profession and love caring for the foot and ankle, sign up at www.podiatry2016.com .

The one constant in medicine is change. Threats of decreasing reimbursements and more restrictive insurance plans due to ICD-10 are among the challenges we face. Despite that, podiatric care will maintain its position as a critical component of the healthcare system in the United States. It is up to you how you face these challenges. Do you let the outside forces bring you down or do you find ways to continue to triumph? ICD-10 has been a big pain in the butt for all of us but now that we are through the hardest part, we need to continue to figure out ways to advance our practices.