Help My ICD-10 Claims Are Getting Denied

For many practices, transitioning to ICD-10 has been no easy feat—especially considering the massive number of codes that are now available. Luckily, though, as a result of all the preparation leading up to the October 2015 go-live date, there haven’t been nearly as many claim denials as there could have been—or may be once Medicare’s grace period comes to end later this year.

So, whether you’ve already faced a denial or you’re wanting to get ahead of the game for when payers start enforcing stricter rules, here are four tips for preventing ICD-10 denials and ensuring you get paid:

1. Check your Codes

Whether you’re using an EMR or still documenting on paper (yikes), the responsibility for submitting the right ICD-10 codes for your patients ultimately falls on you, so take some time to double-check that the codes you should be submitting are the ones that actually are going through. You can do this by performing an internal audit to quality check your documentation against your claims. This is especially important if you’re using an EMR without an intelligent ICD-10 tool. If that’s the case, and you think the software has you covered, think again.

2. Be Specific

The whole point of implementing ICD-10 is to increase diagnostic specificity for patient data. So regardless of what payers are considering acceptable to process payments right now, they’re eventually going to require you to use ICD-10 to its fullest—and most specific—extent.

With that in mind, use this year to practice navigating to not only the right family of codes, but also the most specific codes you can identify that tell the complete story of your patients’ conditions—seventh characters and all. Just be sure that your documentation backs up the level of specificity your codes represent. As this Medical Economics article points out, you don’t want to be left repaying your reimbursement after an audit uncovers that your documentation doesn’t fully support your claim.

3. Do Your Research

The ICD-10 implementation deadline has come and gone, but that doesn’t mean you should stop learning about the coding system or how to navigate tricky coding situations. Rather, your best bet to prevent ICD-10 denials and ensure you’re getting paid is to stay up to date on as much ICD-10 news as you possibly can. Furthermore, you’ll want to keep a pulse on the changing requirements for each individual payer. After all, each insurance provider has its own set of claim specifications. As the above-cited Medical Economics article explains, “Payers may also want specific modifiers added or they may want a specific code used for a procedure.” In other words, you should “know what your payers want before you submit your claims.”

4. Switch to the Right EMR

Your EMR doesn’t need to brew your morning coffee, but it does need to help you stay ICD-10 compliant. Your EMR should do the following:

If your physical therapy software doesn’t do any of the above, then it’s time to replace it with one that does. And fast. ICD-10—as well as every other reporting regulation—only will continue to evolve, in terms of both complexity and intensity. Shouldn’t your practice be evolving with a more comprehensive compliance software, too?

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There you have it: Four tips for preventing ICD-10 denials so you get paid for your services. How has your practice been preventing denials? Fill out the form below and tell us your story.