How analytics can help reduce claims denials before ICD-10 amnesty expires

Claims denials can have a serious and even dangerous impact on provider revenue cycles, particularly if the rejections start piling up. It is imperative that hospitals, health systems, and private practices stay focused on denials trends as well as the specific reasons why their claims are being rejected by payers.

This is especially true as we head toward October 1, 2016, when the Centers for Medicare and Medicaid Services (CMS) ends the “claims amnesty” that has been in place since ICD-10 was implemented exactly one year prior to that date.

Claims denial rates have been low since ICD-10 replaced ICD-9, but once CMS lifts its amnesty, imprecise or otherwise flawed Medicare claims submitted under the new medical and diagnostic coding system will bear greater scrutiny.

Of more immediate concern, as Healthcare IT News reports, is that “some commercial health insurance companies are already insisting on greater specificity for claims filed in ICD-10, particularly those submitted as unspecified.”

People are reporting that some payers are not accepting unspecified codes, asking for more discrete codes. All of which means providers should be trying to improve the accuracy and quality of ICD-10 claims immediately, rather than targeting a deadline several months away.

The best and most accurate way to understand what’s happening with claims denials is to use analytics. By crunching large amounts of data, providers can detect patterns in denials that could point to a common source such as a specific procedure, team or coder.

Listen to this recorded session from HFMA ANI to learn how Orlando Health reduced denials and increased recorded revenue: Reducing Denials and Increasing Revenue with Workflow Design

Or read this article for insight into how you can incorporate data-driven decision making into your workflows: Building an Analytics Culture in the Revenue Cycle

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