With the ICD-10 coding system fully live (as of October 1, 2015), health-care providers of all types and sizes are in the throes of the biggest organizational transition to hit the medical billing industry in decades. The experience is no doubt going a lot smoother for those medical centers and practices that were able to prepare fully over the last year; meanwhile, many others, including smaller physicians’ groups and understaffed, underfunded elder care facilities, are still struggling to catch up.
But across-the-board, all providers are realizing that the success of their transition depends almost entirely on a factor that is largely out of their hands: the preparedness and operations of their vendors.
The government mandated ICD-10 for the health-care industry by specifying “covered entities under HIPPA.” That includes all providers, insurers and other payers, and clearinghouses—but it doesn’t include vendors. And as physicians and hospital systems found out in the lead-up to October, and are still finding out now, not all vendors have felt compelled to comply with the new codes or assist their customers with the ICD-10 preparation.
So what critical functions does this impact?
- EHR/EMR software
- Billing software
- Practice management applications
- Data collection, research, and analysis software
- Dictation, transcription, and voice-recognition coding programs
- Among other, more specified applications and services
For many providers, this means trying to find alternative ways to comply with ICD-10, which is an extremely time-consuming reality.
At the very least, providers can submit ICD-10 claims manually through an insurer or health plan’s website—this can help prevent revenue loss through payment delays, but that’s still a lot of manpower and effort to devote to processing every claim.
But for practices faced with vendors who seem incapable of supporting the transition, or simply unwilling to offer product upgrades to achieve compliance, the smartest step might be to change vendors. Though it is a costly up-front investment, in some instances it may be the only way to keep a practice or health-care system financially viable in the immediate long-term.