Preventing ICD-10 denials comes down to knowledge

In the aspect of quality medical billing and coding the most important factor is denial of claims. Denial happens when there are issues related to billing and coding. Unless the coding and billing is accurate it is not possible to avoid denial. As far as the accuracy rate is high, the denial rate will be low. It is all about making it acceptable with no errors.  There are many medical billing services that use ICD 10 codes to ensure updated and accurate medical billing. To maintain accuracy, the medical billing company has to use trained and skilled billers and coders with updated knowledge about ICD 10 codes.

As far as ICD 10 codes updates are concerned it makes major impact in reimbursement claims and denials. The organization should be updated and skilled to implement the changes that are released at time to be added in the ICD 10 codes. The discussion about claims and denials through ICD 10 codes is worth discussion to come with some conclusion. Moreover in the light of such discussion, the organization has to look up about the performance of the medical claims that they are performing. The billing systems are used to track:

• For the health care payer, the number of days mentioned in the accounts receivable
• The denial rates
• Denied amount of payments
• Contracted rates matched with the payments

Actually such organizations use some metrics for some years such as pre ICD 10 update metrics and then ICD 10 metrics. These metrics are mainly used to compare the results with the performance going on currently.

There are four tips given by Medical Economics regarding preventing ICD 10 denials

Verification of coding

Automatically EHRs are trusted for preparing health records but in case of ICD 10 code selection, it is based on the mappings that don’t end up with correct ICD 10 codes or the most specific ICD 10 codes.

It is advised to double check the ICD codes for generating most of revenues. The codes that are used frequently should be checked twice. This is done to ensure that suitable ICD 10 codes are used for coding.

Customization of forms

Check the super bills used in coding and encounter forms. Find whether there are perfect choices for diagnoses and incorporate the details such as laterality and encounter.

Documentation

Each organization should know that specific ICD 10 codes are assigned by the medical coders. The fact is that the idea about the specific ICD 10 codes can be obtained based on the clinical documentation. Documentation is the origin for specificity.  Each document should be targeted to make sure that the health care providers could justify about the payments that they have to make. The documentation should support the necessity of medical.

Get to know the policies of health care payer

This is most important because there are many differences between the reimbursement and the coverage. Unless the differences are know it is not possible to prevent the denials. Each organization should be mindful of necessities of health care payers.