ICD-10 denial coverage is not the same as denial of coverage
We're still in the ICD-10 denial stage. Meaning healthcare officials deny we have enough data to determine whether the ICD-10 transition is a success or not.
Except for Rhonda Butler at the 3M HIS Blog. She's using the lack of data and judgment as a sign that the ICD-10 transition is nothing to worry about. Her latest post is based upon the following points:
- "Historically only 0.17% of the total claims denied are for an invalid ICD-9 code."
- According to the Centers for Medicare and Medicaid Services (CMS) after one month of ICD-10 coding, denial rates for ICD-9 and ICD-10 claims are down.
- Hospitals aren't raising any real issues.
- So no one should worry about ICD-10 coding increasing rejections or denials.
If I didn't worry about the ICD-10 denial rate, I wouldn't have much to write about. And apparently neither would a bunch of other healthcare writers.
An ICD-10 denial group can:
- Review claim payments and process problems.
- Identify patterns.
- Educate clinicians, documentation specialists and medical coders.
Should be comprised of:
- Patient financial services
- "Closely monitor denials and rejections" Daily.
- "Watch for denial trends." Track by payer, frequency and type.
- "Make changes based upon denial reasons." Once you see patterns, educate.
- "Be prompt." Fix problems quickly.
They also have a guide, "5 Steps to Prevent and Manage Denials."
Providers Not Required to Revise Physician Orders Written Before Oct 1: New CMS FAQ
In response to questions from the provider community, CMS posted a new FAQabout physician orders written before the October 1 ICD-10 compliance date.
FAQ 12625 explains that CMS is not requiring the ordering provider to translate ICD-9 diagnosis codes to ICD-10 on orders written before October 1 for lab, radiology, or any other services.
- Orders written before October 1 should have a ICD-9 codes.
- For orders written before October 1 for services that will continue to be delivered and billed after October 1, providers can opt to use the General Equivalence Mappings (GEMs) to translate the ICD-9 codes on the original order to ICD-10. Providers are not required to update codes to ICD-10 for orders written before October 1.
- Orders written on or after October 1 must use ICD-10.
- California Department of Health Care Services (DHCS) reports a minimal increase in claim denials.
- California hospitals are reporting widespread problems.
- Clinicians are expressing frustration at extra time needed to assign diagnoses.
- Many of the issues can be tracked to specific (and unnamed) electronic medical record systems.
- Review and monitor top ICD-10 diagnoses - not just denied claims.
- Review accounts receivable weekly instead of monthly.
- Enforce ICD-10 specificity before Medicare or other healthcare payers do.
- Create ICD-1 cheat sheets for common diagnoses.
- Audit coding regularly.
There's an interesting story from Deborah Grider about a medical practice that had about 60 Medicare claims denied early in October. The reason was invalid ICD-10 codes. But the practice couldn't find the problem. When it went to the (unnamed) clearinghouse, it was discovered a glitch was stripping off the seventh character from the ICD-10 codes.
This is why medical practices need to jump on denials quickly. It may be a fixable problem causing denials. (Physicians Practice)
- Still early to judge the ICD-10 transition.
- Clinical documentation needs to support the ICD-10 codes
Allscripts interviews one its clients who says the interfaces on their systems worked like magic. So take this with a grain of salt. (Allscripts Blog)