ICD-10 is often described as an “unfunded mandate.” Panelists at the HFMA conference in Las Vegas shared their estimates as to how much that mandate will cost--and the numbers are high.
Tom MacMillan, program manager at North Shore Long Island Jewish Health System, N.Y., said the price tag will be about $50 million. The number spans project management, I.T. remediation, training and other areas. Some 90 applications will be affected and need remediation, he said. The health system encompasses 14 hospitals.
Danielle Reno, ICD-10 program director, at Sutter Health, provided an even higher price tag--well over $100 million, including $60 million for technology remediation and $25 million for a computer-assisted coding program Sutter is implementing. Sutter runs 24 hospitals across northern California.
Both organizations are well ahead of the rest of the industry in their ICD-10 planning, having determined their governance structure and completing their impact assessments. Both are also jumping head first into attempting to analyze the long-term financial impact on their revenue, by analyzing past claims, converting them to ICD-10, and estimating where documentation would need to be enhanced to support the more granular codes in ICD-10.
Both speakers cited a major dip in productivity among billers and coders as an all-but-certain outcome of ICD-10--whose compliance deadline of October 2013 will be delayed, pending a final rule from CMS. The proposed rule calls for an October 2014 compliance date. The productivity dip is one reason that Sutter is deploying the computer-assisted coding software, which analyzes documentation in the electronic health record and suggests a likely code match. Coders still will audit the chart, Reno said. North Shore is launching its own coder training program to help meet the crunch, MacMillan noted.
Reno detailed the I.T. testing challenge ICD-10 represents. At Sutter, some 146 applications will need to be remediated. “It creates a mapping nightmare,” she said. Integrated testing is a long process, considering the multiple steps in the revenue cycle from service to adjudication, she added, citing a “huge risk” to the revenue cycle. Just to obtain hardware to support the testing environment will take 6-8 months, she said, and the cost to run the test environment will be about $1 million.
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