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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