Providers should start preparing now for the implementation of ICD-10, which is scheduled to begin October 1, 2014.  Basically let’s talk about getting your practice's infrastructure in order. 

ICD-10 will accomplish many good things but implementation will be time consuming, expensive, and frustrating.  ICD-10 will have implementation costs.  Various associations estimate the expense at $30,000 per provider.  Listed below are areas that will be affected by the conversion:   

1. Education and Training:  The shear change in the volume of codes is daunting.  ICD-9 has 13,000 diagnosis codes and 4,000 procedure codes totaling 17,000 codes, while ICD -10 has 68,105 diagnosis codes and 72,589 procedure codes totaling 140,694 codes.  The ICD -10 codes will also have more digits and will be in different formats.  Certified Professional Coders (CPC’s) will need to retake exams for ICD-10.  Seminars can be expensive, as is taking the exam itself.
2. Outdated IT systems: Over the years we have been in numerous medical offices and it always amazes me how outdated their IT equipment and systems are.  Let’s face it; in a small to medium medical practice the IT system is not usually a priority.  Hardware and software will need upgrading.
3. Revised billing slips: Every superbill, encounter form, or billing slip will need revising.  Attempts to convert a simple one page ICD-9 billing slip turned into a 9 page encounter form under ICD-10.  Physicians and staff will need time to adapt and become familiar with them.
4. Dual-entry coding:  Some physicians will need to use both ICD-9 and ICD-10.  Workers compensation and auto for example will remain with ICD-9.  A provider can easily send claims needing either ICD-9 or ICD-10 billing codes.  In these cases you and your staff will need to know both.
5. Cash flow disruptions: In other countries where ICD-10 was implemented, there were sizable reductions in productivity resulting in a loss of income to everyone.  TheUnited Statesis the only country to include reimbursements to ICD-10.  Time delays and a very big learning curve will reduce the amount of patients seen.  Resulting in fewer claims processed thus lower incomes.  Then add the payment delays from the largest reimbursement change in 30 years.

The expenses listed above can be eliminated by hiring a billing service.  As a billing service, we are already preparing for all these conversions and more.  Between the cost of implementation and the expected lost revenue from seeing fewer patients I would highly suggest starting a cash reserve to help fund the upcoming disruption.  I would suggest applying for a cash line through your bank now.  The worst time to ask for a loan is when you’re desperate for money, ask now and be prepared for ICD-10.  Basically you’re going to need cash or at least access to cash.  Many practices across the country had financial problems when 5010 was implemented and everyone is predicting this to be much worse.

My best recommendation is:  Hire a billing service like Medical Billing Resources to avoid the infrastructure issues.  Hire Medical Billing Resources for their certified coders and their certified specialty coders.  Hire Medical Billing Resources for their in-house certified ICD-10 client training program.  Then all that remains is learning ICD-10.