Trouble Brewing
By Kathleen Casbarro ICD-10 spells a major adjustment What will Ben’s chiropractic office face with the changes in insurance reporting? Carmen sat on the sofa next to her husband and pulled her feet up under her. “Ben,” she said, taking his hands, “I want to know what’s going on. You picked at my homemade manicotti, you provided no challenge at Wii Bowling, and you didn’t even do the voices for Jonathan’s bedtime story.” Ben smiled ruefully. “You’re right. I’ve got something on my mind,” he admitted. “Remember I told you about the new codes for insurance reporting?”“ICD-10 codes?” Carmen thought back to the previous week, when Ben had told her some government changes would affect his chiropractic clinic. “I remember you didn’t seem to know just how they would affect you.” “Ignorance might have been bliss! I just found out that the effects are going to be significant. The AMA estimates that complying with the changes will cost a practice like mine in the neighborhood of $83,000.” “That’s not a neighborhood we’d feel comfortable in,” Carmen protested. “Things have been rough with the practice already–” “I know,” Ben agreed. “It’s already so stressful dealing with uneven cash flow, I don’t know where I’m supposed to come up with the funds to cover this kind of investment, but it’s not optional. We have to complete these changes by October 1, 2014, or we won’t get paid at all.” Carmen frowned. “Are you sure it has to cost that much? I’m pretty good at pinching pennies.” “I know you are, but this isn’t like negotiating with your suppliers at the pizzeria. I can’t negotiate with the government, and the the new ICD book has 1,107 pages of non-negotiable changes. We’ll need software upgrades, changes in billing practices, training for all the staff… that’s all going to cost.”Carmen and Ben both stared glumly ahead. “Even if you figured out some way to do everything yourself, you’ll have some opportunity costs,” Carmen said. “You’d have to cut down on the patients you see or the other work your team is doing. I’m at your place a lot and I never see people sitting around doing nothing. You’re already running efficiently, so extra time is the same as extra money.” “Exactly. Plus, any change increases the risk that we’ll be audited or that the insurance companies won’t pay claims. We don’t yet know what will be considered medically necessary under the new system, but we’ve heard that there’ll be opportunities for cherry picking. That means that our choice of words in the notes we write up could affect whether or not we get paid.” Carmen shook her head. “You’re already dealing with non-payment of claims, aren’t you?” Ben nodded. “I just don’t see how we’re going to get through this.” “Things are good at the restaurant. And, as I said, I’m good at pinching pennies.” Ben forced a smile. He was lucky to have Carmen, and he knew she’d do what she could, but the stress was getting to him. This was definitely not what he had dreamed of when he had set up his practice. What will Ben’s chiropractic office face with the changes in insurance reporting? Visit our ICD-10 page to see everything we’ve published about ICD-10 diagnosis codes.
Code of Conduct
By Kathleen Casbarro New coding regulations: A major adjustment for chiropractors What will the new ICD-10 codes mean for Ben’s practice? “I’m a lucky man,” said Ben. His wife Carmen had brought an envelope full of family photos to his chiropractic office. The two of them had taken their son Jonathan for a photo shoot in a community park, but the pictures looked as though they had been taken in a pristine forest. “That photographer has skills.” “True, but she also had some great material to work with,” Carmen teased him. “We are a photogenic family,” Ben admitted with a wink. “I want the one with Jonathan on my shoulder for the office. We look so happy!” “That’s because we are happy,” Carmen pointed out. “But you didn’t actually look very happy when I came in. I thought things were going well with the practice.” “They are,” Ben assured her. “But now that I’m getting control over things in the practice and feeling happier at work, I’ve had time to notice an upcoming change in reporting requirements that feels a lot like… hmm… maybe a giant wave coming at me.” Carmen took Ben’s hand. “A trouble shared is a trouble halved. Tell me about it.” “Well, you know we use codes when we file insurance claims. By October 1, 2014, we have to change them all.” “Sounds like some extra work for your staff, but not exactly like a huge wave about to crash over your head.” “It’s kind of hard to know… We don’t know right now which codes for chiropractic will be identified as ‘medically necessary,’ for example, and we know that it won’t just be a question of renaming. We can’t just find all the 724.3 codes and change them to the single new code that will cover it. There are a lot more ICD-10 codes than ICD-9 codes, and there won’t be a one-to-one correspondence. We might need to make some judgement calls about what’s the best new code for a given procedure. If we make the wrong choice, we might not get reimbursed. And that’s just one thing. I don’t really know how many more things there are like that.” “Okay, I can see that you’ll need to be involved in the change. But is it mostly just about learning the new codes?” “I know that the new ICD-10 codes have seven digits instead of five, like the current ICD-9 codes. That could mean all new forms.” Ben frowned. “I guess I just don’t know what’s involved, to tell you the truth. But the government notices have said that it’ll affect scheduling as well as billing, and the way doctors make notes, and — well, pretty much everything we do.” Carmen started putting the photos back into the envelope, leaving out the one Ben had chosen for his office. “It sounds like you don’t have enough information right now,” she said. “I’m not saying don’t worry — it does sound like something to worry about. But it doesn’t sound as though you know the size and shape of the problem yet. It’s like at the pizzeria–” Ben laughed. “Everything reminds you of pizza!” “Okay, that might be true. But when we know we have big parties coming in, that’s very different from just feeling like it’s going to be a busy night. When it comes to this reporting change, you basically don’t know how much pepperoni you need to have on hand.” “Pepperoni sounds good. Let’s grab some lunch and I’ll worry about this stuff later.” “Just don’t leave it too late — October will be here before you know it.” What will the new ICD-10 codes mean for Ben’s practice? See everything we’ve published on ICD-10 on our ICD-10 diagnosis codes page.