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Waiting for the Fiscal Hurricane: It's coming

September 14, 2010
by Pete Rivera
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It's time to prepare for 5010 and ICD-10

It’s common in Florida to watch forecasters tell you about a Hurricane developing off the coast of Africa. You tend to ignore it because it’s way too far. Then you see the forecast a few weeks later and they have strike projections with big arrows pointing at your house. That’s when you start taking it seriously.

If you have not looked at the strike projections for 5010 and ICD-10 and how they will impact your future revenue stream, then it’s time to make preparations. Two distinct but interdependent impacts:

  • 5010 is an update to all billing transactions with your payors, or in the case of a Health Plan, with your customers. This is a high risk change that has a significant impact to your revenue stream.
  • ICD-10 is a complete overhaul of the current ICD-9 coding. ICD-9 contains around 18,000 codes and ICD-10 contains more than 141,000 codes. This change will require extensive technology modifications to software systems, databases, reports, computing logic, data imports and extracts, as well as workflow procedures. The new codes will require extensive training of all clinical staff.

Regulatory Requirements
Federal regulations will require you to adopt the 5010 electronic transaction code sets by January 1, 2012, and by October 1, 2013, to adopt the new ICD-10-CM codes.

Business Impact
A comprehensive project structure must be developed in order to coordinate all tasks required to meet the deadlines. Risk assessments and revenue impact projections must be incorporated in order to mitigate the cash flow variations associated with new codes, rejections, denials and reimbursements.

Senior Executive sponsorship will be required in order to help raise the level of awareness of this initiative and meet resource requirements.

Call it the perfect storm, or Y2K-all over again, or HIPAA on steroids. Either way it’s coming and it’s getting bigger every day.

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