3 medical billing strategies to counter ICD-10

June 25, 2015

Prepare now to fight off lost revenue due to denied claims once ICD-10 becomes a reality with these three medical-billing best practices.

By now you've probably heard the bleak news: nearly every healthcare provider can expect headaches with their medical billing and an increase in claim denials once ICD-10 goes live on Oct. 1, 2015. This increase will be due in large part to coding errors, and even larger part to greater scrutiny by Medicare and commercial payers. So, if you haven't figured out exactly what you're going to do to mitigate losses when these denials start rolling in, now would be a really great time to put a plan into place.

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Here are three ways you can counter these claim denials now and once ICD-10 is here this fall:

1. Designate a point person

One of the first things you can do to maintain your revenue cycle's integrity (and your sanity) is to designate a point person who will be responsible for tracking and trending denials. This person will have the fun of contacting insurance companies, making necessary adjustments to the coding, and resubmitting the claims all day long, so you may want to buy her Starbucks once in awhile.

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Designating a point person won't be as simple as hiring a new person for the job because: 1.) that can be costly; and 2.) many experienced coders are retiring rather than learning the new system. So, look for someone on your staff who is game for the task, detail oriented, and has a solid understanding of how medical billing and coding works.

Next: Get on the phone with your payers

 

Some of the things your point person will be responsible for are:

  • Keeping track of deadlines for submitting claims as well as filing appeals (making note that these deadlines differ for each payer).

  • Flagging any claims that have not been paid as filing deadlines approach (you don't want payers sitting on claims that have already been filed, so your point person will have to be a particularly squeaky wheel).

  • Closely monitor high-dollar and high-volume claims which make up the bulk of your revenue.

  • Attend continuing education courses on ICD-10 to ensure that coding is correct before claims get sent out. This will help decrease the amount of denials that return to your office.

  • Review explanation of benefits for any claim that is denied to determine where the problem lies. You want to appoint someone who is a problem solver so she is not coming to you with each claim denial seeking answers - you don't have time for that.

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2. Get on the phone with your payers

The best way to ensure you get paid after Oct. 1 is to be proactive now, so it's important that you get on the phone with all of your payers, clearinghouses, and billing service to ensure the ICD-10 transition is smooth and your claims will continue to be processed after the deadline without any problems or interruptions. Yes, you may have a lot of people to contact, but each will most likely handle claims a little differently, so being in touch now will help you inform the process.

You'll want to ask each of these payers if they are, in fact, updating their current systems to accommodate the new codes, when upgrades will be complete, if you will need to renegotiate your provider contract or EDI agreement, and if they will be able to receive some ICD-10 codes ahead of time from your practice to make sure they will be accepted. It's a good idea to start calling your biggest payers first and work your way down the list.

Next: Leverage tracking reports

 

3. Leverage tracking reports

Most practice-management software systems (the good ones anyway) have revenue cycle metrics that will allow you to run reports to help monitor outstanding balances by payer and measure against a baseline so your point person can spot any trends that could impact your practice's finances negatively. Most software should also offer a "claim scrubber" to get your claims cleanly through the system.

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Providers that file claims electronically can also get in touch with their clearinghouse and have them run a report for a specified amount of time (say the last six months) to show any trending data on denials and underpayments.

Though many are comparing the ICD-10 transition to Y2K because it seems as if the entire world will come to an abrupt halt come Oct. 1, the key is to be prepared, proactive, and have a plan in place for how you will ensure your revenue cycle faces the least amount of interruptions as possible.

Alex Tate is a digital marketing specialist, content strategist, and a health IT consultant at CureMD, who provides perceptive, engaging and informative content on industry wide topics including EHR, practice management and compliance. He can be contacted at alex.tate@curemd.com.