"We expect expenditures related to coder training, additional FTEs, technical enhancements, IT labor for system upgrades and testing, and consulting auditing fees," Ritchie says.
PRMC also anticipates staff productivity will decrease by 30% to 50% as coders and clinicians get up to speed on the new code set, yet Ritchie expects to see a rebound to 90% of current efficiency levels within six to 12 months.
In addition to lost productivity, Richie says the conversion poses other threats to PRMC's profit levels. "The potential revenue risks include denials and payment errors and could potentially result in a revenue impact of $625,000 to $1.4 million according to [our] ICD-10 impact analysis assessment."
Ritchie says PRMC will begin testing in January 2014, and, like most providers, he is concerned about payer readiness.
"PRMC's team will continue to have conversations with our vendors, and this will help refine our transition risks," he says. "Our biggest concern is whether Medicaid and Medicare will be ready."
PRMC will use its established clinical documentation program, internal communications operations, and physician champions to train and engage its medical staff in ICD-10, Ritchie says.
"PRMC continues to strengthen the physician engagement and alignment approaches through peer-to-peer documentation champions, the clinical documentation improvement program's educational strategies, and department-level education," he says. "We have a dynamic physician champion that is on our steering committee and several other physicians on the physician engagement team. We also publish bimonthly articles on ICD-10 in our physician newsletter."
Protecting revenue with skilled coders
Richard Rosenhagen—who is assistant vice president for electronic medical records, health information management, and clinical documentation improvement programs at Oceanside, N.Y.–based South Nassau Communities Hospital, a not-for-profit, 385-staffed-bed teaching hospital with annual revenues of about $425 million—says his organization is putting an emphasis on coder training because of the potential negative effect on reimbursement if bills are not coded correctly.
"If we perform poorly with ICD-10 coding, it results in a lower payment," Rosenhagen says. "If our coders can do a better job with the available documentation to confirm the accuracy of the coding, it could possibly put us on a different level of payment. Without the accurate coding, we could get the lower payment, so there is a potential monetary impact."