Preventing ICD-10 denials comes down to knowledge

Carl Natale
by Carl Natale
Preventing ICD-10 denials comes down to knowledge

The question of how ICD-10 implementation — and the safe harbor and the 2017 updates — affects claim reimbursements and denials is worth debating. But what's more important to healthcare professionals should be how ICD- 10 coding is affecting their organization.

That's going to require data. In other words, organizations need to track how their medical claims are doing. Hopefully the billing systems can track:

  • Days in accounts receivable by healthcare payer
  • Denial rates
  • Amount of reimbursements denied
  • If reimbursements match the contracted rates

Even more hopefully, these organizations have some metrics from the past couple years — pre-ICD-10 metrics and pre-ICD-10-update metrics. Those metrics can set expectations that can be compared to what is happening currently.

To get denials down, Medical Economics has four tips to help prevent ICD-10 denials:

Verify EHR coding

Trusting electronic health records (EHRs) should be automatic. But the ICD-10 code selection could be based on mappings that don't result in the most specific or correct ICD-10 code needed.

Double check the ICD-10 codes used most often or are responsible for the most revenue (This information is available if data has been collected in the past couple years) to make sure the best ICD-10 codes are used.

Customize forms

Check encounter forms and superbills. Make sure they have the best options for diagnoses (Again, historical data) and include details such as encounter and laterality.

Document well

Everyone should know that medical coders are expected to assign the most specific ICD-10 codes possible. What's possible is defined by the clinical documentation. That means specificity starts with documentation.

And the documentation needs to support medical necessity to make sure healthcare providers can justify they level of reimbursement they are due.

Know healthcare payer policies

It's not news that there are differences in what they cover and how they reimburse. There may be differences in the modifiers required. Knowing what healthcare payers want is the kind of knowledge that is most important for preventing ICD-10 denials.

Preventing ICD-10 claim denials requires knowledge about what healthcare payers expect, strong documentation and correct, accessible information.