5 Ways to Help Ensure Medical Claims Can Be Processed

ensure medical claims can be processedHealthcare providers are facing more challenges than ever when it comes to making sure medical claims are paid. Medical offices are not only implementing healthcare reform provisions, payers are constantly updating policies for reimbursement and pre-certification, along with making coding changes.

Add to that the October 1st, 2014, ICD-10 deadline. With ICD-10 increasing the number of CM and PCS codes from ICD-9’s 17,000 to a formidable 141,000, it’s enough to make any medical office staff member a bit nervous.

The challenge?
Potentially lower reimbursements.

It’s simple. If the correct code is not submitted for the service provided, the claim cannot be processed and it won’t be paid accordingly. But with more than nine times as many codes coming, mistakes are bound to increase – at least temporarily.

The plan?
Stay on top of changes to ensure medical claims can be processed.

Need to ease the transition to ICD-10? Here are 5 things to check to ensure medical claims can be processed and paid as promptly as possible:

1. Check payer’s websites monthly for updates

It is important that office staff check payer’s websites monthly for updates. Many times a claim isn’t processed or paid correctly due to a change in a policy by a payer. Some offices send payer updates, but many do not.

2. Check alpha and numeric coding

Coders often confuse the number “0” (zero) with the letter “O” and the number “1” (one) with the letter “l.” Good news: The letters O and I excluded in the ICD-10 system to avoid confusion with the numbers 0 and 1.

3. Check diagnosis and procedure codes needed to process the claim

It is imperative that both the diagnosis and the procedure are coded. Another must: Check accuracy and ensure complete coding of records and medical records. Functional errors, including records that coded incompletely or codes associated with the wrong medical test, will result in an unprocessed claim.

4. Check medical records

With the implementation of ICD-10, it is important to check specifics found in medical records to ensure prompt claims processing. For example, the coder must specify specific type of chest pains, which may mean looking at the information in the medical record that differentiates them from atypical pains.

5. Check codebooks for accuracy and don’t rely completely on coding software

To cut down on errors, practice management software prepared for the ICD-10 transition may be implemented. This can be a time- and sanity-saving means of moving into ICD-10. However, it’s important for coders to continue referencing codebooks and not develop an over-reliance on coding software.

Taking time to check a few simple areas can help ensure that medical claims can be processed quickly and paid as promptly as possible. As medical providers prepare for moving to ICD-10, taking time to check now can result in a smoother transition. Cornerstone Alliance serves Allen, Auglaize, Hancock, Hardin, Logan, Mercer, Paulding, Putnam, Shelby and Van Wert counties in Ohio. Please contact us if we can be of service to you!

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November Updates from Cornerstone

Welcome to November!

November Cornerstone

Don’t forget to turn your clocks back an hour at 2am on Sunday the 3rd!

It’s that time again – Don’t forget to turn your clocks back an hour this weekend as we shift from Daylight Saving Time to Eastern Standard Time.
Enjoy your extra hour!

It’s a busy time at Cornerstone Alliance as we do our utmost to stay on top of healthcare updates. There are no events planned for November as we gear up for our quarterly Credentialing Committee meeting on December 5th and our quarterly Board meeting on December 10th. We are planning an Annual Meeting for our members on Tuesday, December 3, 2013 from 6:00-8:00 p.m. at the UNOH Event Center. We plan to focus on Marketplace/Exchange plans that will be offered in our service area via the Federally-Facilitated Marketplace/Exchange effective January 1, 2014. An important update was forwarded to our members about these plans and how they will affect our members. We will do our utmost to keep everyone informed and – as always – please contact us if you have any questions.

CLICK HERE for October updates at Cornerstone, including information about the Ohio Exchange/Marketplace:
Ohio Exchange Carriers

We have learned that Molina Healthcare will not be offering an “Exchange Product” in Region 2 of the State of Ohio. Therefore, Cornerstone will not pursue an “Exchange Agreement” with Molina Healthcare.  If you have questions regarding this or any information about Cornerstone, please contact Harold Bischoff, Executive Director of Cornerstone, at 419-996-5317 or hlbischoff@health-partners.org