October 31, 2011

ICD-10: The Ostrich Syndrome

By

I was on a recent call during which a middle manager for a healthcare provider noted that his hospital wasn’t doing anything to prepare for ICD-10 implementation because “our vendors are taking care of all that.” To that apprentice executive I say welcome to Oz, because if you believe that, you’ll believe anything!

Here’s the deal:

I’m a “vendor,” and we certainly are taking care of ICD-10 from our perspective. But our perspective is similar to that of a payer: we are going to be working exclusively with claims you generate. We’ll be prepared to handle them correctly – a full year before Oct. 1, 2013 – but the old clichéd bit of wisdom “garbage in, garbage out” still applies.

Consider the following (and we’re confident you agree):

  1. Our system will be able to handle claims with ICD-10 diagnosis codes as well as ICD-10 procedure codes (for both inpatients and outpatients) and CPT/HCPCS codes (for outpatients). This is the point at which someone reading this will scream: “Idiot! You can’t use ICD codes on outpatients! What a dummy!” Well, guess what: surprise! The Transaction Rule doesn’t apply to everyone or all circumstances (like workers’ compensation, for example).
  2. Continuing: suppose that we tell you we can process ICD-9 claims before Oct. 1, 2013 and either ICD-9 or ICD-10 claims thereafter (again, to cover the bases, if a claim is not covered by the Transaction Rule.)
  3. But suppose you send me a Medicare claim coded with ICD-9 after Oct. 1, 2013 and I tell you we won’t handle it – because you can’t bill that claim and why in the world did you think you could (or we would)?
  4. Finally suppose you come back to me and say: “But our vendor told us it was OK, and they’re taking care of it.” Sigh.

Two fundamental, unremarkable, self-evident truths arise from this exchange:

  1. We won’t process your claim no matter how much you try to make it “the vendor’s” problem.
  2. You won’t get paid.

It doesn’t get much simpler than that.

So, here’s the truth:

  1. Your vendors are not going to take care of you. They’re going to take care of themselves, and merely provide you some tools you must leverage to be in compliance when the hammer falls on Oct. 1, 2013.
  2. If you aren’t prepared to test ICD-10 by Oct. 1, 2012 (a full year early), there’s a good chance you won’t make the 2013 deadline. And that’s when the CEO is going to find a sacrificial lamb to face the board of directors and try to explain why your organization stopped being paid on Oct. 1, 2013.
  3. If you aren’t already engaged in the process of finding every area of your organization impacted by ICD-10 (which at a minimum is every clinical venue you have), then it already may be too late.  No, scratch that. It’s not too late, but you likely are going to represent a lot of money for my “brothers and sisters” in the healthcare consulting business.

It’s one thing to procrastinate; it’s quite another to pretend that something inevitable isn’t going to happen.

If you think ICD-10 is just going to swirl around you and implement itself, you probably can be diagnosed with a terminal case of “ostrich syndrome,” first identified in the trenches of World War I and brought to clinical perfection during the Cold War  (“Bombs? What bombs?”)

 


 

If you are diagnosed with “ostrich syndrome,” you have one – and only one – course of action:

Pull your head out of the sand and smell the stinking Transaction Rule Flowers

That have grown right up under your feet.

It’s time to get to work!

About the Author

Billy K. Richburg, M.S., FHFMA, is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle business segment of MedAssets, Inc. His office is in Plano, Texas.

Contact the Author

To comment on the article please go to

Read 114 times Updated on September 23, 2013
Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.