Dealing with ICD-10-related payment delays

December 7, 2015

No matter how prepared your practice is, some payment delays due to the ICD-10 coding transition will happen. Here's how to keep them under control.

No matter how prepared your practice is, some payment delays due to the ICD-10 coding transition will happen. Here's how to keep them under control.

After years of stern warnings and friendly guidance, most practices did a good job of preparing for the new ICD-10 coding system, with adequate training and a financial cushion to tide them over in the case of delayed payments in the early stages. But some payment delays are inevitable, and smart practices will have a plan for dealing with them.

"We don't have a lot of feedback yet," said Robert Wergin, MD, president of the American Academy of Family Physicians, "but practices need to stay on top of claims-problems can add up quickly."

15 humorous holiday ICD-10 codes

Wergin recommends having a system for tracking denials and queries so that you can find out why your claims are being rejected and correct any problems promptly. "Is it a coding problem? A workers' compensation issue? Problems with the individual's policy? Locate the mistake, correct it, and resubmit" Wergin says.

It doesn't stop there, though. "After you've found what the mistake was, find the source of the problem and make sure it doesn't happen again," Wergin said. It could be a physician not giving enough information to a coder, a coder not using the proper codes, or you may have missed a change in policy on the part of a payer. If you don't find out why your claims are bouncing back, it will just keep happening.

The longer you wait to correct and resubmit, of course, the longer it will take for your practice to get payment, delays that can hurt your bottom line and possibly cause you to have to draw on your credit or dip into your cash reserve. If you wait too long, you may not get paid at all. Filing deadlines vary from payer to payer, and if you miss them, you're out of options.

"You're busy-everyone's busy-and it's hard to pay attention to little claims," Wergin said, "but little claims add up fast; Stay on top of the remittance process. If you do, you may not have to dip into those reserve funds."

Next: Important tips from our ICD-10 Diary physicians

 

Feedback from our ICD-10 Diary physicians:

Daniel Mark Siegel MD, MS
Dermatologist
Brooklyn, New York

Another important thing to do is share your experiences with your local, state, and national societies.  The obvious typo or miscellaneous code corrected to a specific code that goes through on the second pass is not newsworthy.  The seemingly correctly coded claim that is denied may be as simple as a flaw in the payer's software or, more ominously, a test by the payer to see what they can get away with.  Your payment policy staff may see the obvious fix, but if to them it looks like you are doing the right thing (and you are the 30th person to call them in the last day) action may be called for and their chance of having a meaningful discussion with a decision maker is better than yours. 

Pamela J. Miller, OD
Optometrist
Highland, California

I am finding that it is the doctor who must designate the code–staff really isn’t able to do it or glean the exact code from the patient record. I am not certain how much the office billing and coding folks are able to do and pretty much am finding that they are able to do the billing only. Coding is basically the practitioner’s responsibility and cannot be delegated. Time constraints require that codes be recorded immediately after seeing the patient. To wait only complicates the underlying problems and can easily result in late submissions or even inadvertently overlooking submissions.

Lessons the ICD-10 codes has taught me

The doctor absolutely must remain vigilant-it is not uncommon for an office biller to simply file rejected claims, resulting in lower office income. Thus, the doctor may think that everything is going along smoothly and it could conceivably be months or even years later when this practice is uncovered – too late to remedy the loss or even discipline or fire the employee.

Next: Steps that are absolutely critical to know

 

Most doctors do not maintain a line of credit or have any significant amount of cash reserves on hand. In fact, I am finding that most offices are running very close on their income and outgo ratio, with the bottom line being that there is very little left over after expenses are taken care of.

It is absolutely critical that any claim rejections are addressed immediately and corrected for resubmission. If errors continue to occur, it is prudent to maintain a checklist to minimize the recurrence of rejection.

Thomas A Marsland, MD
Oncologist
Orange Park, Florida

In a business model that lives on cash flow, payment delays can have devastating effects.   The take home message is to continue to track EOBs closely and if there is a denial, to see why and if it could be related to a coding issue from the ICD-10 transition. It is critical to appeal any denials and report codes that are appropriate but not included to the policy people for correction.  Success rests with attention to details.

Mile Brujic, OD
Optometrist
Bowling Green, Ohio

I would echo "paying attention to details!"  They do add up significantly when you extract that over a month or a year...