October 1

It’s been about nine months since the initial implementation of the ICD-10 diagnostic codes, and so far hospitals and physician practices appear to have remained calm during the adjustment period. By most opinions, switching from the older 1CD-9 codes to the newer, more complex and specific ICD-10 codes did not produce the greatly feared spike in denied or rejected insurance claims that could hinder cash flow; the majority of coders seem to be doing it right.

Expected Change

Experts report that the presumed increased denial levels just aren’t happening. But a few experts anticipate this will all change after October 1. That’s the date the 12-month ‘grace’ period – when a significant number of health insurers and Medicare agreed to accept less than perfect coding – ends. It was an entire year when they wouldn’t reject or deny mistakes or inaccuracies that would otherwise result in unsuccessful claims. The looming fear now is that come October 1, there could be an entirely different experience.

Additional Fallout

The sudden increase of denials after October 1 is not the only likely fallout expected. It appears, according to a survey done in March by the Workgroup for Electronic Data Exchange, that healthcare providers who are struggling with required clinical documentation and code selection, are demonstrating a decrease in productivity. The hope is that with time and familiarity, more and more healthcare providers will master ICD-10’s coding demands and will bounce back to their previous pace.

False Sense of Security

There is a rising concern that the one-year grace period may have done more harm than good in some ways. The fear is that it has lulled a large number of physicians into a false sense of security, or general complacency, at a time when they should have been mastering the requirements of ICD-10.

Medical practices are strongly urged to monitor their claim denials carefully to understand the reasons for the denial. Was an invalid code used? Were medical necessity requirements met? Was an unspecified code used? Denial analysis can help identify and correct diagnostic coding errors before the October 1 deadline.

Has your organization experienced an increase in denials since rolling out ICD-10? Has your coding team mastered the ICD-10 requirements? Let MedPartners help make sure your organization is ready for life after the grace period comes to an end on October 1. Let us show you what we can do for you!

 

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