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Keeping Claims from Becoming Denials in ICD-10

Keeping Claims from Becoming Denials in ICD-10
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Contributed by: Daniel Schwartz

Daniel Schwartz is a content strategist who sheds light on various engaging and informative topics related to the health IT industry. His belief in technology, compliance and cost reduction have opened new horizons for people in the health care industry. He is passionate about topics such as Affordable Care Act, EHR, revenue cycle management, and privacy and security of patient health data. He can be contacted at https://twitter.com/dschwartz20


Contributed by: Daniel Schwartz (click to view)

Contributed by: Daniel Schwartz

Daniel Schwartz is a content strategist who sheds light on various engaging and informative topics related to the health IT industry. His belief in technology, compliance and cost reduction have opened new horizons for people in the health care industry. He is passionate about topics such as Affordable Care Act, EHR, revenue cycle management, and privacy and security of patient health data. He can be contacted at https://twitter.com/dschwartz20

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One of the most important medical billing practices to adopt is to catch potential denials before those claims ever get submitted.
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Have you ever found a recipe in a magazine that you wanted to try? You did your best to follow the directions but when the timer dinged, what came out of the oven was a literal hot mess?

That’s a bit what it’s going to be like submitting claims once the ICD-10 training for physicians is official. You and your staff will do your best to follow directions and submit claims, hopeful and anticipating payment, only to have your claims sent back to you labeled a hot mess.

But you won’t be alone. Most healthcare providers will experience billing headaches and increased denial rates starting October 1st. Though CMS has recently announced a 1-year grace period, private payers have not mentioned they would do the same. And, once that government grace period is over, you can be sure Medicare will scrutinize claims even more looking for coding errors.

So, if you haven’t yet begun to incorporate some billing best practices to help you mitigate revenue loss when those denials start rolling in, now would be a good time to do so.

Adopt the Right Technology

If you resisted technology so far, ICD-10 will be a game changer. You can save time and money while reducing administrative hassles by using electronic transactions. You’ll want to make sure your medical billing software uses electronic transactions by confirming the system will accept electronic remittance advice (ERAs) from payers. ERAs are great because they standardize reports so that computers can easily read payment information. They also make it much easier for providers to ensure that payments and contracted amounts match up.

Different providers have different plans to use technology effectively for ICD-10. What works for them might not work for you but will give you a general idea of how to leverage these tools effectively.

Dr. Navarro, just shifted from an EMR only solution to an integrated EMR and Practice management system, as this way her vendor, CureMD, would be able to monitor payor readiness on her behalf and submit claims in the correct code set. She feels this will take a huge burden off her staff allowing them to work on other areas needing their attention for ICD-10.

Angela, is a practice Manager who has had a tough time convincing her provider to put in the time for improving his clinical documentation for ICD-10. “Hospitals have the leverage of forcing physicians to become compliant with ICD-10 by imposing “no access to EHR” policies if they don’t comply. In small practices, we don’t have the leverage to do that. We will depend on Athena to guide him in his documentation; there is not much else we can do.”

Catch Denials Before You Submit the Claims

The likelihood you will ever receive a payment drops significantly once your initial claim has been denied. So one of the most important best practices to adopt is to catch potential denials before those claims ever get submitted. Obviously if you are using an outside billing vendor, they will scrub your claims and make sure they will get paid on time, every time. If your billing is in-house, be sure you are using quality medical billing software with automated billing rules built right in. This feature will help spot problematic claims before they are submitted.

Another great thing about catching potential denials is that it accelerates the average length of time until you get paid. This also frees up a lot of staff time that would end up being spent on renewing denials and the subsequent frustrating back and forth dance with payers to resolve any issues.

A final note on billing software: since billing rules are constantly changing, be sure you select software that has a history of frequent updates to keep up.

Closely Monitor Your Receivables

No one likes having to follow up on late payments, but it’s simply part of running a practice. The sooner these late payments are followed up, the less likely the claims will end up sitting somewhere being ignored. Most practices typically track their receivables based on 30-day increments and from there will take any number of actions depending on whether the receivables are 30, 60 or 90 days old. But this traditional model simply doesn’t apply any longer.

Because each payer is operating on their own individual schedule, two 60-day-old receivables from 2 different payers will require very different actions. For example, you may find Medicare might take 14 days where a private regional payer may take up to 40 days or more to pay. Using the typical 30 day follow up doesn’t work here because 30 days is far too late for Medicare and too early for the private payer.

Though it takes a bit more time and effort, you’ll have a much better shot at getting paid if you act according to each payer’s schedule. Using a good billing software package again makes monitoring receivables much easier.

Track Ignored or Denied Claims

Just as the right software will make monitoring receivables that much easier, the same can definitely be said for tracking ignored or denied claims. Look for billing software that has some essential features such as collections queues (this is an automatically updated list of assignments), broad scope ( this feature gives you the ability to see all ignored and denied claims so you can easily keep track at a glance), electronic claims status checking (lets you know when you can expect a payment or when you should follow up on a claim), and standardized denial types (when this is noted it means you can act on denied claims faster and avoid future denials).

When your software can do these tasks automatically you will find your office runs more efficiently and you can get paid faster. A win/win.

Manage Payer Contracts

Another revenue hit typically comes from payer underpayments. Usually this stems from the multiple, complex contracts. Tracking these underpayments is next to impossible with all of the other daily tasks your staff is handling. Here again is where the right software can help tremendously by storing contract details for all payers and automatically compares actual payments with negotiated rates for each payer.

It seems with each passing month new healthcare reform requirements cause revenue cycle management to become increasingly complex. More than ever before it is important that providers be proactive as much as possible and set in place strategies and best practices that will help them bill more efficiently, and, as a result, get paid more often and much faster.

 

Daniel Schwartz is a content strategist who sheds light on various engaging and informative topics related to the health IT industry. His belief in technology, compliance and cost reduction have opened new horizons for people in the health care industry. He is passionate about topics such as Affordable Care Act, EHR, revenue cycle management, and privacy and security of patient health data. He can be contacted at https://twitter.com/dschwartz20

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