Control ICD-10 Claims and Denials: 4 Tips

When the transition to ICD-10 begins Oct. 1, 2015, healthcare providers will have an additional 135,000 codes for documenting a patient's medical status and reason for a doctor's visit. Based on the additions of these codes CMS predicts that claim error rates will be more than two times higher with ICD-10, reaching a high of 6 percent to 10 percent in comparison to the current 3 percent average using ICD-9 codes. They are also predicting that denial rates will rise by 100 percent to 200 percent and days in accounts receivable will grow by 20 percent to 40 percent.

 Now is the ideal time to prepare. Start by:

1. Identifying current high dollar or volume procedures as these will have the most impact to your business;

2. Developing current baseline trends by payer, clearinghouse, procedure, and diagnosis code;

3. Documenting timely filing rules for each payer to ensure you do not get denied for slow staff processing; and

4. Working with payers to create scorecards and a real-time feedback process so impacts can be communicated quickly.

A little preparation now will go a long way next year.

Aaron Hoodis vice president of product management for RemitDATA, provider of denial management tools to medical practices. E-mail him at AHood@remitdata.com