There has been a lot of talk recently about potential changes to the ICD-10 implementation date. Unfortunately, all that talk about moving the deadline has turned the government into the boy who cried wolf – a government with a credibility problem when discussing ICD-10.

In recent weeks, we’ve watched as the AMA, lead a charge to insert multiple years of ICD-10 delay into the recent Omnibus spending bill. One House of Representative member has promised a congressional hearing on ICD-10, and there is some quiet discussion about the potential for delay in the annual SGR patch bill, which comes up for discussion in March.

It’s estimated that the last one-year delay would cost billions to the industry as whole, but what’s the impact to individual provider organizations, and what would be the impact of another delay?

Examine ICD-10 Demands

To describe the impact, it’s easiest to look directly at the work required:

There are actions that a hospital will take on the transition date, whatever that date ends up being, e.g. detailing one of our analysts to watch EDI transactions for trends that need addressed. We are going to do and pay for those things one time anyway, so moving the date doesn’t really add to cost or workload.

There are quite a few longer-term items that need to be completed to prepare for the ICD-10 transition. Let’s look at these items:

Software Upgrades – There is no way to avoid the ICD-10 software upgrades. You still have to do them, if for no other reason than any future upgrades require the previous ones to also be done.

Coder Education – Here is an area where there may be added costs associated with a delay — ICD-10 knowledge of coders who have been trained more than a year in advance of the ICD-10 transition date and haven’t used their training is significantly impacted. Many hospitals completed most or all of their coder training before the delay was announced last year and now expect to do that training again. If another delay would be announced in April, the same scenario is likely to reoccur.

Physician Education – The impact of educating physicians in documentation requirements for ICD-10 is significantly different from that of educating coders. ICD-10 documentation is not a new documentation system, it’s just an expansion of previous documentation. There is no reason a physician cannot learn what is needed for documentation under ICD-10 and begin applying it today. There may be a revenue benefit to doing so.

General Staff Education – Like coder training, staff education needs to happen one time, likely closer to the transition date. Assuming that any future delay comes with at least six month’s notice, there is unlikely to be much impact here except perhaps some subscription fees if you’ve already purchased a subscription based training tool.

Reporting – Getting all reports, including those developed outside of your systems in spreadsheets and databases ready for ICD-10 and ensuring you have the reports you need to evaluate your claims flow can be a significant effort. However, this is an effort that you still need to do one time only, and evaluating and updating your reports could assist you in the next item.

Assessing Revenue Cycle Health – The ICD-10 transition will have significant effects on cash flow. With a healthy revenue cycle, a hospital can maximize the cash on hand, as well as be better prepared for ICD-10 interruptions. ICD-10’s impact on the revenue cycle will most likely mirror what we see when implementing a new billing platform – a well-functioning revenue cycle sees small blips in AR during the transition, and a poorly functioning one sees large blips that take longer time to resolve. The revenue cycle that’s well managed will experience a smaller hit to cash flow at transition time. The ones that don’t will magnify their pain exponentially.

Achieving a healthy revenue cycle, one with low days in AR, quick turnaround on appeals, and fast responses by providers to coding queries isn’t just good ICD-10 preparation – it is best practices that you should be doing anyway.

Bottom Line

As I evaluate the impacts of a potential delay, it seems that hospitals should not get too excited. While a delay in ICD-10 would affect the timing of a number of things, the only truly significant additional expense that most hospitals would face in the event of a delay is the need to repeat some coder training. As a result, Phoenix is generally advising our clients to continue with most of their ICD-10 preparations as though there is no possibility of delay.

If you’re seeking ICD-10 or Revenue Cycle guidance, review our services. We have experts on staff to guide your hospital toward a healthy revenue cycle and ICD-10 preparedness.

Also, you can hear one of our experts discussing revenue cycle on ICD-10 Monitor’s Talk Ten Tuesday radio show here.