Creating a game plan for dealing with an increase in denied claims during the first few months of ICD-10 can save you money and headaches.
When ICD-10 goes live in less than a month, it's quite possible that things will go very smoothly for most providers. CMS has agreed to give a break on specificity and not deny claims as long as the submitted code is in the right family of codes. This should help a lot during the early days of the transition and if providers are lucky, private payers will offer the same grace period. "When Medicare does something, other payers usually do, too," said Fletcher Lance, vice president and national healthcare leader at consulting firm North Highland. "Private payers won't say they're going to, but my hunch is that they will follow suit."
Regardless of whether or not payers across the board go easy on coding mistakes in the first months of ICD-10, most providers are braced for some increase in denials. Bonnie Dominick, billing manager at Associated Family Practice in Philadelphia, is relaxed and ready for ICD-10. She is relieved that for the first year, CMS won't deny claims for lack of specificity. Even so, she's ready for a few extra denials. "We always take care of denials as soon as they come in, so we have a plan in place for that," Dominick said.
Dominick has the right idea. In addition to having a financial cushion to tide you over while claims are resubmitted, it’s a good idea to have a system in place for managing claims that bounce back. If you have done all your training and testing and are completely ready for the transition, you should be spending these last few weeks putting together a game plan for denials, if you don't have one already. And if you're still scrambling to get ready, make some time for this anyway.
Even though coding will be slower and time will be at a premium for the first few months, it's worth the effort to make sure refused claims are worked promptly. "Practices should implement a denials process, in which denials and rejections are worked every day and one that has a 24-hour turnaround time," said Asia Blunt, an AAPC-certified coder and trainer. Blunt also highly recommended setting up a tracking system so that you can monitor the reason codes for denials and rejections. "This way you'll know which payers you are having trouble with, the reasons your claims are coming back, and you can address these problems and revise your workflow and processes accordingly," she said.
After you've done all that? "Revisit selective training," said Lance. You can never train too much.