Avoiding Claim Denials Under ICD-10

Posted by | September 2, 2015 1:38 PM

Once ICD-10 (International Classification of Diseases, 10th Edition) is mandated in doctors’ offices across the United States, the required update will change the way conditions are diagnosed and claims are processed. In fact, this upgrade from the ICD-9 system not only expands the available coding possibilities, it enables practices to be more precise about describing their patients’ treatments.

However, due to the extensive revisions to this code structure, the risk of claim denials is expected to rise between 100 to 200 percent after the transition to ICD-10 takes place on October 1st. According to studies conducted by the Centers for Medicare and Medicaid Services, this high rate of rejection is a cause for concern. Such conflicts could have a dramatically negative effect on providers’ revenue because of the delay in payments. Furthermore, administrative costs may grow because of the resulting appeals.

But there are certain things you can do in your small practice to prevent claim denials under the new ICD-10 system. Generally speaking, attention to detail is key.

Documentation

ICD-10 offers greater flexibility in code creation, enabling 3 to 7 positions over the current 3 to 5 places that are built into ICD-9. Therefore, when ICD-10 is implemented, it’s essential to provide as much information as possible to ensure the most accurate codes are selected for each claim.

This means that the more you can do on the front end to verify all of the necessary data and coding are included, the less likely a claim will be denied. While claims can certainly be fixed after their submittal, it’s more costly and time-consuming to correct errors once they’re in the hands of payers.

Assessment

In order to address the potential for claim denials under ICD-10, you need to understand your present baseline rate of rejections. By obtaining a comprehensive picture of where you currently stand, you can move forward with a more detailed plan to eliminate this possibility in the future. Since there is only a month left before ICD-10 arrives, you can install fixes to your system to accommodate this upgrade.

In the process, take a look at the current specificity of your patients’ charts. Based on your analysis, has your staff integrated sufficient detail to generate codes that will meet ICD-10 standards? If not, now’s the time to start getting your employees in the habit of including the necessary information for successful ICD-10 codes.

Training 

ICD-10 is not a simple upgrade from the ICD-9 code structure that’s now in use. It’s actually a much more complex system that cannot be mastered just days before launch. That’s why you need to organization a training schedule right away.

As you introduce the new ICD-10 rules to your staff, evaluate their level of knowledge. Then you can take the time to address any issues now. Otherwise, potential misunderstandings could become obstacles when ICD-10 becomes the required coding system.

Testing

The implementation of any upgrade should include testing. So build in time before the October 1st deadline to evaluate whether your codes are descriptive enough for the new ICD-10 perimeters. You may consider developing some test claims that you can put through your internal and external systems and see how they fare. Practicing beforehand will help you perfect the process prior to the transition.

One Final Note

It may seem stressful to focus on the upcoming ICD-10 arrival, especially since you already run a busy practice. But if you don’t prepare for this upgrade now, your office could be left behind on October 1st.

 

 

Comment