Maintaining Positive Cash Flow in the midst of the ICD-10 Transition

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By Dr. Steven J. Kraus, DC, FIACN, DIBCN, FASA, FICC

The transition to ICD-10 has represented significant challenges for many providers – from significant time focused on paperwork and processes to dealing with delayed or denied claims. And there is nothing that quite gets the attention of a squeaky wheel when that wheel is cash flow. Protecting your practice -  and your profits -  has quickly become paramount in the midst of such a radical change in coding standards, and having a clear game plan is mission critical to get back to positive cash flow. Prior to the transition, experts warned that productivity and profits would be the two factors that will be most affected during the ICD-10 transition period, and now that we’re in a post-ICD-9 world, focusing on both must be top of mind.

According to a recent study published in the Perspectives in Health Information Management journal on the subject of ICD-9 to ICD-10 coding, "The prevailing estimate of productivity loss is typically somewhere between 30 and 50 percent”. Some results came in even higher, citing that coding is expected to take anywhere from 54 to 69 percent longer. These are sobering statistics for any provider who now finds that reality and estimates have are closely aligned, especially if you perform all of your billing tasks.

While productivity takes a bite out of the financial picture, some practices are finding denial rates making a substantial dent as well. Just prior to the transition, the Centers for Medicare and Medicaid Services estimated that denial rates would surge, rising by as much as 200 percent in the early stages of the ICD-10 implementation.

This means providers need to have the funds available up front to carry their practices through lean times. If the transition is resulting in plunging reimbursements for your practice, you’ll still need to cover staff salaries and rent in order to keep their doors open. Some providers heeded the urging of the American Medical Association to set up a line of credit and start saving months before the transition – but, in reality, most did not have the means to do so.  The impact is likely to be less on a chiropractic practice than it is for a medical practice.  And even if a practice was excellently prepared and codes correctly, there are issues on the payer side in the form of cash flow disruptions that are further delaying payments.

In the midst of all that is currently weighing down the ICD-10 transition, there’s good news—it doesn’t have to be so difficult. And for those who do find themselves and their practices suffering from ICD-10 issues, there are some steps you can take immediately to reverse the situation.  The sooner you implement these the sooner you can get back to doing what you do best: helping your patients find health.

1: Employ a Supportive EHR System

Your EHR system is the cornerstone for the health and growth of your practice. To properly manage your business through tough times (you know – like a complete upset of your traditional code set) you need a system that had taken care of these challenges ahead of time. If your EHR system had not been actively advising you prior to the transition and how they planned to help you navigate through the choppy coding waters you now find yourself in, then it’s time to find a vendor who has a plan that can still be implemented now that the transition has taken place. Look for the following support system in an ideal EHR vendor:

  •       ICD-10 Implementation Tools

Tools such as ICD-10 wizards should help you quickly navigate the ICD-10 transition by offering an easier way to migrate codes and instantly access each code set. Look for vendors with tools that can:

o   Index codes and search for diagnostic terms and conditions.

o   Edit individual payer information for ICD-10.

o   Easily categorize codes by laterality, condition, and anatomical location to help you quickly and easily choose the most appropriate code.

  •       Consultation with Industry Experts

Your EHR vendor should be well-connected across the country and should be inviting industry experts into their development discussions to help them determine the most applicable and common ICD-10 codes used by their clients.

  •       Ongoing Support Services

Look for robust support services and supporting documentation that can help you get the most out of your software, along with an online community forum where you can interact with fellow users and share tips and tricks along the way.

Your EHR system should be backed by an industry name you can trust and one in which you can place your full confidence. With ICD-10 raining challenges on your practice, your EHR provider should be holding out an all-encompassing umbrella.

2. Consider Outsourcing Your Revenue Cycle Management (RCM)

Maybe it’s time to consider taking a load off and assigning your billing tasks, posting and account receivable management to the experts. By outsourcing your RCM, you can increase your collections and retain precious revenue throughout these trying times. Protecting your cash flow and keeping your claims from declining into a tidal wave of denials can help you keep those reimbursement checks coming. Getting on board with an outsourcing company is key in order to avoid the projected rate hikes that may hit as the ICD-10 implementation increases the demand for such services.

Outsourcing can reduce expenses, improve collections, provide better practice analytics, offer more consistent results, reduced errors, and minimize disruption. With less time focused on your billing, you’ll have more time to focus on the patient-centric aspects of your practice.

3. Train Your Staff

With roughly 50,000 more codes than the ICD-9 code set, there is more to this transition than a simple one-to-one mapping. Training your staff is imperative to a smoother ride through this initial period of conversion. If you haven’t already, implement an education plan that can help you reduce loss of productivity, increase the accuracy of claims, and get your practice’s cash flow back in the black. Not to mention the morale benefits that will be gained by empowering the staff and letting them know you’re all in it together.

It’s easy to understand how many practices hadn’t focused on ICD-10 prior to the transition as it had already been delayed several times. But now that it’s here and potentially causing issues for your practice doesn’t mean you can’t ramp up quickly and get your practice back in order. With the right vendor on deck, a proper training schedule, and outsourced revenue cycle management, you can put the breaks on the mammoth toll ICD-10 may be having on your practice.

About the Author

Steven J. Kraus, DC, FIACN, DIBCN, FASA, FICC, is the Chief Market Strategy Officer for ChiroTouch―the nation’s #1 provider of chiropractic-specific EHR/practice management software. He is an acknowledged expert in Health IT, including EHR (electronic health records) and HIPAA issues affecting chiropractic practice and EHR. To learn more about maintaining positive cash flow for your practice from Dr. Kraus, visit