The Centers for Medicare and Medicaid Services (CMS) predict that the number of claim denials will nearly double and reach 200% in the very near future. Well, all these are ominous signs for healthcare providers who are already battling the high cost of ICD-10 implementation.
With this is mind, we have put together a list of steps that will help you to overcome future ICD-10 claim rejections:
Coding errors are one of the major causative factors for majority of medical claim rejections. Hence make it a point that you keep this costly mistake out by undergoing rigorous training with regards to the usage of ICD-10 codes. Also make sure that you review the latest healthcare payer policies and streamline your billing procedures with the current standards, so that your claims are complete and accurate.
Keep track of time
Carryout appropriate research and collect stats about how long it takes for healthcare payers to reimburse claims. Yes, things are going rather slowly than ever before in the current reimbursement scenario, but that does not mean that it will take forever to receive your money. Hence, whenever there is a major delay by the healthcare payer, consider it as a sign that there is problem with your outstanding claims.
Find the source of your problems
Make it a point that you track the reasons for denials and rejections, which will go a long way in identifying issues with your medical practices. Hopefully, the problems are administrative slip-ups that can be fixed with minor tweaks in medical claim processing.
However, if the reason behind claim denial is the shift in payment policy, the road to reimbursement will be a lot bumpier that you have ever imagined.
Communicate internally with the staff and educate them about the potential pitfalls in coding and documentation that can adversely affect reimbursement. Also spread the word about potential pitfalls and rejection with the larger healthcare community, and opt to learn from others mistake. And finally use the takeaways from rejections as a valuable guidance on how to prepare proper medical claims.
In the future, healthcare providers will have to create more coordinated denial management efforts across multiple settings, which can potentially drain the practice by taking critical resources away, say experts. The only way you can effectively combat this situation is by hiring the services of an outsourced partner that is well versed with handling the nitty-gritties of sterner ICD-10 compliance like us.
A better way to reduce claim denial is to outsource the task of claims management to experts like us. We have a well-planned and meticulous system to help you prioritize ICD-10 claims, identify problems, prepare an action plan and initiate solutions for the entire bunch of outstanding claims. We also provide insights into the cash reimbursement processes employed by different payers and establish benchmarks for processing patters, which will help you effectively measure key ICD-10 parameters such as processing time, denial rate and so on.