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What Will Be the Financial Impact of ICD-10?

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ICD-10 Question:

What Will Be the Financial Impact of ICD-10?

What will it cost providers to prepare and make the ICD-10 transition?

Will it cause a delay in reimbursement from payers?

 

Our Answer:

I think everyone is concerned with the financial impact of ICD-10, including most providers, facilities and payers. For providers, the financial impact of training will vary significantly dependent upon the size of the practice and staff. For instance, I estimate that a practice with an in-house staff of  5 employees, including 2 full-time medical coders, should expect to spend approximately $6,500-7,000 on lost time, books, etc for the training itself.

Once the transition takes place, the financial impact will turn more to reimbursement of the actual claims. In many cases, a patient encounter will be paid at a different reimbursement amount when it is coded in ICD-9-CM, versus coding the same encounter using ICD-10-CM or PCS.

Once ICD-10 is underway and there is sufficient claims history to be collected, experts will likely be asked to analyze ICD-9-CM and ICD-10-CM and PCS claims to determine shifts in coding and reimbursement trends that have impacted provider and practice finances. It’s possible that these findings could result in CMS making changes to coding policies, claim editing, and provider educational strategies.

It’s new to everyone involved. We will have to wait and see, but I do feel like most providers will not be as prepared as they hope so we will see a significant financial impact, then an outcry and hoopla, followed by subsequent changes to certain aspects of the system by CMS.

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