Start Preparing Today to Prevent ICD-10 Denials
October 1, 2015 – and with it, the mandated shift to the ICD-10 code set – is right around the corner. Though the implementation date has changed before (three times since 2009), there seems to be no postponement on the horizon this time around.
The CMS recently successfully completed its first week of end-to-end testing of ICD-10 coding and announced its opinion that the “industry is ready to take the next step to modernize healthcare.” But they may not be right about that. A new survey found that only 21 percent of physician practices feel they are on track with preparation efforts. That’s not a good sign!
Are you prepared for the switch? According to the Healthcare Information and Management Systems Society, providers will likely face delays in processing authorizations, increased claims rejections and denials, improper reimbursement, and slowed or reduced cash flow as a result of ICD-10. Some of those effects may be unavoidable, but there are a few steps you can take now to minimize the impact of ICD-10 on your practice’s operations.
How and Why to Perform a Medical Billing Audit
If you’re happy with your practice’s reimbursements and you haven’t seen a recent spike in denials, you may feel like your medical billing operations are coasting along just fine. But is fine good enough?
It’s critical for practices large and small to earn every dollar they can. If you don’t periodically audit your systems, efforts, and results on the medical billing front, you’re almost certainly not operating at your optimum performance level.
How in-depth you decide to go with an audit is up to you… but more is better (especially if it’s been a while since you revisited your billing policies and procedures). Since every medical practice is different, there’s no one-size-fits-all checklist for auditing billing and coding, but there are some general steps every office should take and key considerations along the way.
Healthcare Analytics and Medical Billing Services
Medical billing services typically know how to dodge the manual errors, timing issues, and outright mistakes that frequently cause claim denials. (Denials due to ineligibility, missed filing deadlines, and plain old miscoding are common across all specialties.)
Avoiding these common claim errors will help reduce overall claim denials, but to really lower your rejection rate, your coders or medical billing company must have an in-depth understanding of the big picture.
Through healthcare analytics tools we can shed new light on denial patterns across many practices. These are the top five most commonly denied procedures and the payers’ associated reasons for denial. To help you keep these denials from slowing down your revenue cycle, we’re also sharing our common-sense wisdom on avoiding them.
Medical Billing Tips - Simplify Payer Enrollment
Using CAQH to Simplify Payer Enrollment
Working with payers is not always easy. (Denied claims, long remittance times, and coverage disputes have likely caused more than a few headaches at your practice.) But thanks to an initiative from the Council for Affordable Quality Healthcare (CAQH), provider enrollment with payers is a little simpler than it used to be – giving you less reason to reach for the ibuprofen.