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presentation

Are physician practices in for a spell of revenue loss during ICD-10 transition?

March 27, 2012



“And when clinical and operational efficiency suffers on account of whatsoever reason, it gets reflected in terms of dwindling revenues. As if this cause and relationship is not enough, physician practices will have to contend with direct expenditure associated with sourcing learning materials. The combined effect of these two factors would doubly affect their revenues and financial equation.”

While most of the physician practices are earnestly making arrangements for transition to ICD-10 and HIPAA-5010 compliant clinical data management, there seems to be an undercurrent of probable revenue loss that these practices will have to cope with during their course of ICD-10 transition. Such apprehension gets founded mainly on the premise of training and technology needs of ICD-10 and HIPAA 5010 compliant clinical and operational management being on the heavier side. Not discounting ICD-10’s potential to be the promoter of clinical and operational efficiency in the long-run, there seems to be an ounce of truth in physicians’ apprehension of it being costly in the initial or transition phase.

ICD-10, which in a distinctive deviation from its predecessor ICD-09, happens to be a domain of more than 100,000 new alphanumeric procedure and diagnosis codes. It is quite a challenge not only to physicians but also support staff for medical billing practices. When you are suddenly asked to decipher and learn coding in such gigantic proportions it is quite natural that your operational efficiency is going to suffer till such time when you are actually done with the task of becoming familiarized with the new coding manual. And when clinical and operational efficiency suffers on account of whatsoever reason, it gets reflected in terms of dwindling revenues. As if this cause and relationship is not enough, physician practices will have to contend with direct expenditure associated with sourcing learning materials. The combined effect of these two factors would doubly affect their revenues and financial equation.

More than the expenditure associated with learning materials for ICD-10, it is the implementation of HIPAA-5010 (seen as the operational platform for ICD-10), which is going to add up to the woes of revenue loss. The HIPAA-5010 EHR platforms, (comprising automated clinical and operational management software), despite their credible performance have grown to be costlier than their earlier versions. And, even if physician practices somehow manage to source funds for upgraded versions of EHR platforms, there is always going to be the concern of orienting the internal staff to a more demanding EHR mechanism. Therefore, till such time when physician practices are able to demonstrate the requisite efficiency for augmenting medical billing reimbursements in ICD-10 and HIPAA-5010 regime, they will have to contend with the inevitable revenue loss. Technically, they will have to wait for the time when they actually break-even, before considering a positive rate of return (ROI) on investments done on ICD-10 clinical and operational requirements.

While it is inevitable for physician practices to pass through the imminent revenue-loss stage, they can still try to contain the margin as far as possible through an alternative course of action: outsourcing their billing and coding functions to credible medical billing companies. These medical billing companies – by virtue of being service providers to voluminous clients – carry the tag of economies of large scale operations while also being adept at offering customized solutions in sync with physician practices’ individualistic needs. Medicalbillersandcoders.com (www.medicalbillersandcoders.com), the largest consortium of medical billers and coders with credible competence in offering ICD-10 implementation strategies for small as well as large medical practice settings, may well be your preferential recourse to alternative course of ICD-10 transition.

 

Category : ICD-10 Coding