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Are You Coding to the Highest Degree of ICD-10 Specificity?

The flexibility offered during the transition to ICD-10 coding disappeared as of October 1, 2016. Now, all providers need to precisely reflect clinical documentation per the coding guidelines and assign codes to the highest degree of coding specificity. A lack of documentation supporting the code can lead to the dreaded claim denials.
 
The Cancer of Claim Denials
 
Not only can claim denials severely impact your bottom line, but handling them is time consuming, labor intensive and can rupture patient relationships. All denial fixes occur after the claim has been processed and the damage done.
 
Proactively Dealing with Claims Denials

A proactive approach to eliminating or at least minimizing claim denials is to consistently follow a pre-bill management process which can be effective at catching some potential denials. Coupled with analytics, a simple yet effective pre-bill process is the start to mitigating denials and the headaches that accompany them. Good analytics stem from continually probing for who, what, when, where and why to detect the root cause of claim denials. Use analytics to chart trends and denial types such as coding miscues and missing documentation.

Preventable Denials

Industry statistics suggest that 90% of claim denials are preventable and 67% are recoverable while as many as 65% of denials are never reworked.  

Often, denials occur from deficient documentation from the patient consult, the time when interventions and diagnoses need physician substantiation to ensure compliant coding. Even then, pinning down the cause to a problem can be a slippery process. For example, sometimes providers chalk up denied claims to subpar coding when the true root cause was incorrect patient demographic information collected during the admission or registration process.
Tips to catch preventable denials:
  • Monitor the top 25 ICD-10 diagnoses rather than only denied claims. This can further be analyzed by volume and revenue generated (or lost).
  • Develop a pre-bill edit list for an additional level of supervisor review.
  • Continuous clinical documentation improvement strategies with providers to identify documentation-related issues requiring additional education/information.
  • Verify claims billing system upgrades and reset automated payor billing edits.
  • Enforce ICD-10 specificity.
  • Embed monitoring and auditing ICD-10 coding into the practice.
  • Utilizing computer assisted coding (CAC) to promote compliant coding rooted in the integrity of clinical documentation. However, final code selection is to be based on coding guidelines, clinical documentation, and compliance protocol.

Testimonials


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We have had a good working relationship...we can pick up the phone and discuss issues easily and in person.
We receive excellent service and solutions to solve whatever problems that we may have had.
I can't thank you guys enough for helping me negotiate my bill. I'm so glad there are folks like you around.
I have been extremely satisfied with the performance of RMK. They have worked very closely with our practice helping us to carry out the billing process efficiently.
Thank you for working with me and my situation to repay my balance.
RMK is very competitive and works hard to recover revenue for delinquent patient accounts.
We appreciate being alerted to issues, that if adjusted in our practice, could increase our revenue.
The response to our questions, concerns, and requests for specific information has been very prompt and accurate.
I have many medical bills that have much larger balances than the one I have with you. Thank you for working with me instead of being sent to an automated payment system.

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RMK Holdings Inc.

111 North Avenue
First Floor, Suite 104
Barrington, IL  60010

866-446-4800 toll-free phone

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