Now that ICD-10 is here, what’s next?

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By Teri Thurston, Billing & Coding Manager

Congratulations! You have made it through the first couple of weeks of the ICD-10 transition! Practices have shared that things are going well, with limited issues to date. Claims are being accepted by insurance payers with minimal rejections. This is good news and a huge relief! However, we are not in the clear yet, we still need to be proactive and watch for issues impacting cash flow.

Here are some recommendations to keep your cash flow on track.

Continue to submit claims daily. Not submitting claims in a timely manner may delay payment. If there is a delay submitting claims, note the number of days delayed before submitting. This will help to trace the expected timeframe in receiving payment.
Monitor rejections through the clearinghouse and understand the cause. Use the rejections and denials received to gain valuable insight on areas that need adjusting or additional training. Include rejections caused by clerical or registration errors.
Keep a watch on the dollar amount of outstanding rejections and the overall denial rate per month and track improvements.
Payer policy changes may have occurred due to the ICD-10 transition. If receiving denials for services when the ICD-10 code was valid, review the payer’s policy for additional clarification. Modifier rules and usage still apply. Continue to append as prior to October 1st, including eye modifiers.
Check with payers three weeks after mailing CMS-1500 claim forms to ensure claims are being accepted and processed. Do not wait the typical 45 days to see if payment is received. This will allow for early intervention if there is an issue.
Watch for payment delays. Insurance payments should continue to be received during the same time frame as prior to Oct. 1st or close to. If payments are delayed inquire as to why and when to expect payment. Be proactive. Insurance payers should offer communication of any lengthy delay. Check payer websites or clearinghouse alerts for updates.
Track the number of days’ insurance claims stay on the accounts receivable before payment is received. If there is an increase, have a clear understanding as to why and deicide when, if necessary, to activate your contingency plan.
Keep in mind, ICD-10 codes do not drive the reimbursement. Reimbursements are derived by the value of the CPT code therefore all reimbursement amounts remain the same as prior to October 1st. Review payment vouchers regularly and inquire if there are any discrepancies.
Consider adjusting the frequency in working the accounts receivable to a daily or weekly basis instead of a bi-weekly or monthly basis. This will allow for quicker resolutions of the current claims, but also help avoid future denials as well.
As we become more comfortable with the new code set and move forward into 2016, continue to modernize and restructure gaps in any processes. Make modifications to new forms, super bills or EMR templates when necessary to accommodate the daily workflow. Continue coding training to become fluent with the new code set. What about those old office policies you’ve been wanting to change? With the year end approaching, and patients hearing about changes in healthcare, it could be the perfect time.

Do you have questions on ICD-10?

PECAA’s Billing & Coding team is here to help. Please feel free to contact Teri Thurston at teri@pecaa.com or call 503.670.9200.

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