Sunday, August 14, 2016

ICD-10 Denials Increase for Practices


ICD-10 – a diagnostic coding system developed by the World Health Organization, is in its early implementation stages, and it has already caused the health care organizations to cope with a number of challenges arising due to poor education and preparation regarding ICD-10. Poor education regarding this new coding system has led to a number of consequences, including compliance issues, claim rejections, coding backlogs, delays, and denials.
In this article, we will be discussing how implementation of ICD-10 has led to increased number of denials and what an organization can do to limit the impact of this new coding system on its denial rates.

ICD-10 Denial Rate Forecast

The health IT industry, has published white papers predicting that the implementation of ICD-10 will lead to a 100 to 200 percent increase in claim rejection and/or denial rates.
Explaining that during the post-implementation phase of ICD-10, healthcare organizations may experience significant impact on the length of time and amount of rework required for claim rejects and their productivity. Practices may suffer a negative impact of ICD-10 on their cash flow and revenue due to lost productivity and increasing number of coding errors.
The companies recommended that organizations should measure their denial rates and types of rejects or denials during the transition phase in order to plan and act accordingly.
  • Of 4.6million claims submitted every day, only 2 percent were rejected because of invalid or incomplete data.
  • About 0.09 percent claims were rejected due to invalid ICD-10 codes.
  • About 0.11 percent claims were rejected due to invalid ICD-9 codes.

3 Most Common ICD-10 Denials

The implementation of ICD-10 can prove to be a bumpy ride for your practice if you haven’t done enough preparation. In order to gain maximum benefit from this transition and to minimize denial rates, it is important that you act proactively.
To help you do so, we are listing 3 most common ICD-10 denials and ways to avoid them.
  1. “Diagnosis Code: Invalid; Diagnosis code must be most specific.”
The new ICD-10 coding system provides specific codes for specific condition. In order to avoid denials due to unspecific codes, select the most specific code for each condition and claim.
  1. “Diagnosis Code: Invalid; Must be a valid ICD-10-CM diagnosis code.”
Denials that specify the above reason can be caused by a number of issues. In order to avoid these denials, choose the most specific and valid ICD-10 code that rightly represents the patient’s documented condition.
  1. “Diagnosis Code: Invalid; Claim cannot contain a mixture of ICD-9 and ICD-10 codes.”
In order to avoid claim denials due to this reason, make sure that the outpatient claim contains either ICD-10 or ICD-9 codes.
The best way to handle ICD-10 rejections and denials is to stay proactive. Educate your staff on how documentation and procedures may affect denial and rejection rates. Learn from the denials and establish best practices on how to prepare proper medical claims.

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