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With Grace Period Over, Denial Tracking Is the Answer

On Oct. 1, you lost the ICD-10 reporting grace period that the Centers for Medicare and Medicaid Services (CMS) granted to help ease you into complying with the new diagnosis coding system. So, why should you care?

For the past year, you’ve been receiving payments for claims that were coded close to the target.  All you were required to do was code in the correct family and that was good enough. The problem is, that during the past year, Medicare payers didn’t give you much feedback when your coding wasn’t actually accurate. That means, now that the grace period is over, instead of these claims getting paid, they’ll be denied.

And when asked how you can prepare for the grace period’s end, CMS offered this rather obvious advice: “Avoid unspecified ICD-10 codes whenever documentation supports a more detailed code. Check the coding on each claim to make sure that it aligns with the clinical documentation.”

So I reached out to our ICD-10 expert, Lynn Anderanin, CPC, CPPM, CPC-I, COSC, to get her take on what you can do to avoid these denials. First of all, she suggests tracking denials to identify trends. “It’s easier to identify trends if you’re using some kind of spreadsheet,” she says, because they allow you to “sort the data based on specific information.”

You can then look at denials based on different criteria, including insurance carrier, diagnosis code, and CPT® code, among others. Breaking down the information this way then allows you to create policies and tips to effectively address the trends. For example, you can develop appeal letter templates if you see repeated denials from specific payer or for a frequent procedure or service.

“You can also assign staff to specific denials based on their knowledge and experience,” Anderanin says. “A clerical person can process a denial requesting medical records, and you can assign a coder to a denial that the insurance carrier is stating is coded inappropriately.”

And tracking denials also allows you to figure out “why you’re getting the denial in the first place. Then you can communicate with those who are entering the charges and doing the coding to let them understand what the problem is, and if there’s something they can do about it on the front end,” Anderanin adds.

Over the next few months, denials for ICD-10 errors will likely spike. If you take Lynn’s advice and set up a denial tracking mechanism, however, you can quickly address each identified issue, fix the errors, and avoid any significant impact on your practices bottom line.

 

Take Aways:

  • Tracking denials and using them to identify trends by provider, ICD-10 code, and other parameters can give you tools to nip the denial in the bud.
  • Trending denials can show you where you may need more resources to head denials off at the source.
  • Effectively communicating with front-line staff can mean addressing issues to avoid denials in the first place.
 To ensure you stay compliant with ICD-10-CM coding rules and guidelines, check out the Coding Leader online ICD-10 training page at http://codingleader.com/collections/icd-10. Each session listed gives you access to national experts that walk you through a specific aspect of ICD-10 compliance in plain-English so it’s easier for you to comply.