4 Tips for Preventing ICD-10 Denials—and Getting Paid

February 1st, 2016
EMR, ICD-10, Insurance, Preparation

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.


How to Deal If Your EHR/EMR Doesn’t Support ICD-10

January 26th, 2016
EMR, ICD-10

So, you need to code using ICD-10, but your EHR or EMR didn’t upgrade to the new code set? The solution here is simple—and absolute: You need new software. (Don’t act like you didn’t know that was coming.) Sure, the CMS grace period allows you a small amount of flexibility, but it definitely doesn’t provide you with a get-out-of-ICD-10-free card. If you’re currently working with an out-of-date vendor, you’re probably already losing revenue due to denied claims, which means you’re up a creek. The good news? We’ve got a paddle. To correct your course, here’s what to look for in your new software:

An intelligent ICD-10 tool

Your EHR/EMR doesn’t need to be smarter than a fifth grader (unless you know any ten-year-old medical coders), but it does need to be highly intelligent when it comes to ICD-10. Here are a few questions to ask potential vendors to ensure your new software gets an A for more than effort:

  • Does it prompt you to document specific details of the patient’s injury or condition?
  • Does the code selector prompt you to choose more specific codes when greater specificity exists? (And let you know when you’ve selected an invalid or non-billable code?)
  • Does the EMR base its ICD-10 code library solely on GEMs? (That’s bad, BTW.)
  • Does the EMR claim to have an automatic one-to-one crosswalk from ICD-9? (Also bad.)

A library of both ICD-9 and ICD-10 codes

Some non-HIPAA-covered entities (like auto and workers’ compensation companies) weren’t required to make the switch to ICD-10. If you ever have to submit claims to these payers, you may still need the ability to use ICD-9 codes, so make sure your new software is equipped with both code sets.

Free system updates

ICD-10 is not the last code set update we’ll ever see—not by a long shot. In fact, the World Health Organization plans to endorse ICD-11 in 2018. And there are updates coming to ICD-10 in October 2016. Plus, the government frequently releases regulatory updates to HIPAA, PQRS, FLR, AEIOU, and sometimes Y (just kidding). But seriously—there are tons of reasons why your new EHR/EMR could slip behind the times, and you don’t want to get stuck footing the bill for any mandatory changes. That’s why you should pick a vendor that updates your system:

  1. automatically,
  2. at no charge to you, and
  3. with as little downtime as possible.

Not sure how much downtime is acceptable? Take a look at this article from PTEMR.net.

Free ICD-10 training, support, and resources

You can’t put a price on great customer service—and if your EHR/EMR vendor truly is invested in the success of your practice, it won’t, either. Look for vendors that offer educational resources and a support team ready to assist you via phone and email—all for the low, low price of $0. (P.S. The best EHR/EMR companies make this kind of support available on all topics, all year round.)

PT-Specific Design

Of course, ICD-10 functionality isn’t your only consideration when picking a new EHR/EMR vendor. You’ll want to make sure your new software comes complete with all the other features that make it easy for a physical therapist to succeed in business, including:

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Without a solid EHR/EMR partner in this ICD-10 world, your financial outlook may be fairly bleak right now. But if you find a system that’s the right fit for your practice, then pretty soon you’ll be rowing your boat gently down the revenue stream once again. Keep in mind that once you select your new software, you’ll still need to develop your game plan for a smooth switch; check out the tips in this article to ensure a headache-free transition.