- The transition from ICD-9 to ICD-10 made coding and billing more tedious and, coders complain, increased rejections; ICD-10 added codes for all possible services, so correct coding gets claims paid right.
- Confirming whether a patient has changed contact information or insurance since the last visit takes only a few seconds at the front desk and can positively affect denials.
- Reading the codes and denial reasons thoroughly reveals whether the same issues keep causing denials; if many claims are rejected for the same reason, the solution is already identified.
- At least 50% of the time, ICD-10 rejection can be ruled out by having staff read and proofread claims before submission, which produces cleaner claims and fewer delayed payments.
- Educating billing staff on ICD-10 codes and the transition is the first step, since the people who enter codes and start billing must understand what changed in order to curb rejections.
The transition from ICD-9 to ICD-10 made the medical coding and billing process more tedious. ICD-10 brought in codes for all possible services, and you can in fact get paid right with this coding, provided the coding is correct. Coders do complain that ICD-10 has increased rejections, but dealing with ICD-10 rejection is possible, if not simple. Here are five ways to stay clear of claims rejected simply because coders have not yet got the hang of the ICD-10 system.
1. Stop underpayment at the source
The path to getting underpaid often begins with assuming that every patient understands the EOB. Nipping the problem at the bud is the best solution, and the processing issue can often be solved by explaining in detail how claims get underpaid and why payment takes longer.
Patients always have useful information to share. It does not take hours to check whether a patient has changed their contact information or insurance company since the last visit. Do not expect patients to volunteer these details. Front-desk staff may find it tedious, but this minute detail takes only a few seconds to ask for and can positively affect denials.
2. Use your practice management software
Are the same issues causing denials? You will not know until you have read the codes and the denial reasons thoroughly. Run through them and identify the underlying cause. If you see a major percentage of claims rejected for the same reason, you have already arrived at the solution. If your practice management software cannot pull the required data, it is time to upgrade the software.
3. Read and proofread
At least 50% of the time, you can rule out ICD-10 rejection with ease, provided you pay attention to the claims. Before submission, ask your staff to read and proofread to identify potential errors. When there is confusion about which codes to use, or entries seem mystifying, this strategy helps rule out the chances of going wrong with the codes. A clean claim submission brings down the chances of rejection and delayed payments.
4. Use updated medical billing software
Is your medical billing software up to date? Changes in ICD codes have also caused changes in the software. Contact the software company if you feel it has not been updated. It is not enough that updated software is used; the billing executive who uses it should be educated on any changes and comfortable using it.
5. Educate your billing staff on ICD-10 codes
This is actually the first step you need to take. Train your staff on ICD-10 and the transition, with vigorous training to ensure no errors are committed. If you need to improve cash flow, your focus should be here. The right way to hit rejection is to ensure that the people who enter the codes and start the billing process are aware of what the changes are.
When you are not concentrating on ways to curb ICD-10 rejection, your claim denial percentage keeps growing and payment delays follow. Preparation and training can rule out most rejections.
Frequently asked questions
Why did ICD-10 increase claim rejections?
The transition from ICD-9 to ICD-10 made coding and billing more tedious, and coders complain it increased rejections. ICD-10 added codes for all possible services, so claims get paid correctly only when the coding is right.
How can front-desk staff help reduce claim denials?
Front-desk staff can check, in just a few seconds, whether a patient has changed their contact information or insurance company since the last visit. Capturing this detail can positively affect denials.
How does reviewing denial reasons help prevent rejections?
Reading the codes and denial reasons thoroughly reveals whether the same issues keep causing denials. If a major percentage of claims are rejected for the same reason, the underlying cause and the solution are already identified.
Does proofreading really cut down claim rejections?
Yes. At least 50% of the time, ICD-10 rejection can be ruled out by having staff read and proofread claims before submission. A clean claim submission lowers the chances of rejection and delayed payments.
What is the first step to filing error-free claims under ICD-10?
Educating billing staff on ICD-10 codes and the transition is the first step. The people who enter codes and start billing must understand the changes, and vigorous training helps ensure no errors are committed.