August 21, 2012

Why is ICD-10 So Hard to Get Done? I’m Livid

By Denny Flint

Every Tuesday, I’m supposed to sound off in this segment on Talk-Ten-Tuesday. So far, I’ve been sounding off in whispers and not with the sound and fury of a so-called expert advocating for providers.

At 6 a.m. this morning, the script I originally wrote for this segment went in the trash – and let me tell you why. After reading Chuck Buck’s article this morning, it’s time to sound off in a way you haven’t heard before.

Frankly, after reading Chuck’s article, I’m livid. If you haven’t read it, please do. He talks about the possibility, based on rumblings from that puzzle palace we call Washington D.C., for yet another delay, possibly a year. Another year? Are you kidding? Why is ICD-10 so hard to get done? It has been more than 20 years since its development. HIPAA was passed in 1996, mandating a standardized code set. The final rule for ICD-10 adoption was issued in early 2009. What’s the problem? It’s the law, people!

In our segment a few weeks ago, a guest talked about ICD-10 implementation in Palestine. If Palestine can do it, surely we can! So again – what’s the problem?

Find a group of 100 physicians and ask them what ICD-10 really is, and what it means to their practice. Maybe five can tell you. How do I know? It’s because I ask several times a month in my workshops. Ask that same group of docs what they think about ICD-10’s ability to level the playing field as it pertains to tactics used by the insurance industry, or to create valid acuity databases with which to report diseases, or how it can increase, yes increase, reimbursement. And what do you get? Crickets. The reason providers don’t have a clue is that no one is really telling them what ICD-10 means. No one is advocating for the providers on this matter. You can’t expect the AMA to watch its back when a jump to specific Dx-based reimbursement would mean a serious hit to the purchase of CPT® books.

Why are perfectly sane and intelligent people waiting to start the process? Early or late preparation is like rooting for your home nation in the Olympics. Every fan has an agenda tied to cheering on their flag. How you look at ICD-10, and how motivated you are to begin, depends on from where you come.

If you’re from the country of Insurance Land, you know it’s going to be an expensive IT and process upgrade, but the investment will be validated in light of the inevitable struggles affecting all those practices that delay or forego an orderly ICD-10 transition. Those that arrive to the game too late to be effective will become subject to denied claims. Those claims will need follow-up, thereby allowing the citizens of Insurance Land to invest money. Bottom line? They’re licking their chops.

If you’re from Doctor Land, you have two teams for which to root. Maybe you support that side of the country that wants ICD-10 to go away so your professional association can make lots of money from sales of CPT® books. Or maybe you root for the other team, which is aware that ICD-10 is inevitable and that it presents unique opportunities for physicians.

What about the United States of CMS and HHS? You actually get to fix the game! All you’re trying to do is see the match finish. You know the final score is inevitable and just want to see it end according to the pre-ordained outcome. Well, puzzle palace, get off the bench and get it done so we can get on with the rest of our lives!

A tough game is coming up on the schedule. Which team do you want to play for, when the time comes? Do your own homework. Ask hard questions of your peer leaders and organizations supposedly advocating on your behalf. Alas, if the government delays again, as I was quoted in Chuck’s article, I become the boy who cried wolf. Who’s going to listen? It will just be me and Henny Penny running around in the yard screaming about skies falling and wolves circling.

But here’s the conundrum. As the Grateful Dead noted, what happens when the dire wolf, 600 pounds of sin, shows up at your window – and all you can say is come on in?

What do you do then?

About the Author

Denny is the president of Complete Practice Resources, a healthcare education, consulting, and software company headquartered in Slidell, Louisiana. He formerly served as the CEO of a large, multi-specialty physician group, full service MSO. Denny has authored or co-authored numerous “common sense” practice management books and implementation manuals. He is an award winning, nationally known consultant, speaker, and educator bringing his expertise to making the complex “simple.” He currently serves on the editorial board of ICD10 Monitor.

Educated at the United States Air Force Academy, Denny had a distinguished career as an Air Force pilot and has a long history of commitment to excellence and dedication to his clients’ success.

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