With the impending implementation of ICD-10, it’s important that your facility deploys a strong Denials Management campaign. Denial rates are expected to jump 100-200% when ICD-10 hits the market, and healthcare facilities nationwide are developing strategies to combat this. There are many factors that currently lead to denials, but in healthcare, the most common type is medical necessity denials (the diagnosis you are billing does not match the CMS medical necessity guidelines). In preparation for future changes, here are a few important questions regarding Denials Management you may want to consider:
- Do we currently have a strong Clinical Documentation Improvement (CDI) program in place?
- How are chart deficiencies handled? Are our providers buying into the process?
- Could we lend our attention to creating stronger communication between coders and providers by implementing software allowing them to freely communicate? How would this affect our denials rate?
- In regards to reimbursement, do we currently have an efficient billing process that maximizes quality while lowering costs? How will this change with ICD-10?
- What can we do to avoid the denials associated with the granularity of ICD-10 and the problems it poses to the billing process?
- Is there potential to outsource some of our work, enabling us to focus on ICD-10 and its impact to our facility?
- What else can we do in regards to protecting ourselves by avoiding denials associated with ICD-10?
Enabling coders to document their questions for physicians in a one-to-one environment can rapidly correct chart deficiencies while identifying errors that may lead to a claim denial. This can be achieved with a configurable software solution that allows coders to review a chart and ask the physician a question by completing a deficiency form, which the physician can view and easily respond to by clicking through a deficiency list. Coders can produce at higher rates, and providers can better understand the importance of their role in the process.
ICD-10 will affect the billing processes of all facilities, making it a high priority for hospitals to focus on. By delegating some of the more manual tasks involved in these processes to an outside vendor or streamlining them with a software solution, many organizations are able to shift more employee focus to ICD-10 strategy development and other pressing initiatives instead. Organizations can also review cross-departmental collaboration, dual-coding procedures, and root-cause analysis as a means to increase preparation for ICD-10. This is a risk-reward, cost-benefit type of concept that is certain to produce beneficial outcomes. Outsourcing specific tasks such as patient chart scanning or optimizing billing processes with a software solution are both great ways to ensure operations continue to run smoothly in the wake of ICD-10. To learn more about how our patient chart scanning services work and how we’ve helped other healthcare facilities, download our Southcoast Health System Case Study below!