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Learn Your Post-ICD-10 ABCs: Audits, Big-data and Coding Drive Denial Management Success

ABC_Blocks_1Believe it or not, ICD-10 has now been in use for six months. As we move forward, it’s important to take control of your denial management strategies and shift the focus from ICD-10 implementation to optimization. To continue being an ICD-10 champion for your organization, it’s important to understand your ICD-10 ABCs—hopefully putting them into practice will be as easy as 1, 2, 3:

1. Audits: We may be in tax season, but don’t worry–this type of audit doesn’t need to be scary. With ICD-10, ongoing audit processes are required for compliance. Use these audits as a feedback mechanism to your organization’s benefit. You can even expand audit use to inform clinical initiatives like tailored care and population health management.

2. Big data: ICD-10 is expected to generate new insights in denial analytics, and we’re just beginning to skim the surface. With claims processing and innovative business intelligence dashboards, you’ll be offered a large-scale look at data trends along with the ability to zero in on specific focus areas like your denial rate to monitor for and rectify reimbursement performance issues.

3. Coding: With the Medicare specificity grace period coming to a close this year, it’s critical your organization understand all the ins-and-outs of coding compliance. If coding denials do begin to occur on a more frequent basis, one way to make improvements is to automate your appeals process. Your clearinghouse can help you load a series of templates to address appeals more quickly, auto-populate certain fields and even send batch letters.

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Though Medicare reported a slightly lower denial rate for the first quarter following ICD-10 implementation, there’s still plenty to learn about ICD-10 implications for claim requirements. Documentation and medical review requests may initially trend up but should go down long-term. The goal is to proactively address possible issues during initial claim filing, and have a process in place to respond as quickly as possible to reduce added personnel time and keep reimbursement rates high.

Access the on-demand webinar How to Work a Denial to learn more about ways you can reduce denials and maximize your reimbursement.

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