ICD-10: What’s the Cost?

Moving from ICD-9 to ICD-10 will result in lost revenue. It is unavoidable.

Practices can expect a 20-percent to 40-percent loss of productivity in the first three to six months after ICD-10 takes effect on Oct. 1, 2014, says Denny Flint of Complete Practice Resources in a video interview with TMA Practice Management Consultant Heather Bettridge.

A study (PDF)  released by 12 health care organizations predicts transition to the new coding system will cost solo physicians as much as $83,000 each, and group practices up to 10 doctors as much as $250,000.


 In addition to cash flow disruption, the study identified these key areas of significant costs:

  • Staff education and training;
  • Business-process analysis of health plan contracts, coverage determinations, documentation; 
  • Changes to superbills; 
  • IT system changes; and
  • Increased documentation costs.

The study says physicians can expect a permanent increase of 3 percent to 4 percent of their time spent on documentation for ICD-10-CM. Also, as health plans modify their contracts to include the more specific codes, they may alter their payment schedules, resulting in changes to a practice’s cash flow.

According to a June 2013 Medical Group Management Association (MGMA) press release, only 32.5 percent of respondents to a survey reported their vendor would cover the cost to upgrade or replace their practice management system software. Only 37 percent said their vendor will cover the cost to upgrade/replace their electronic health record (EHR). MGMA identified its greatest concern as “the lack of communication and critical coordination between physician practices and their essential trading partners … regarding software updates and testing, which has not yet occurred. 

Practices that prepare well in advance for the change will fare best, Mr. Flint noted. He also recommends building a “war chest”: Take full advantage of EHR incentives, for example. Refine your practice’s coding and documentation habits so you are getting paid appropriately for your services now. And, learn how you’ll need to document for the ICD-10 codes you’ll use most, so your practice won’t stumble over coding after Oct. 1, 2014.

 TMA can help you prepare. Visit our ICD-10 Video Vault for more quick Q&As covering a variety of ICD-10 topics. Be sure to bookmark TMA’s ICD-10 resource page for news, tools, education, and updates.

 Did you miss TMA’s recent seminar on preparing for ICD-10, ICD-10 Now! How and Why? It is now available as an on-demand webinar through the TMA Education Center. Check out TMA’s toolkit, Complete ICD-10 Implementation Solution, a “virtual consultant” that can guide you step by step through the ICD-10 transition. It comes with two licenses for Simple Solutions ICD-10 Transition Software and instruction videos. You can view a four-minute demo.

Published July 23, 2103 

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