Avoiding Common Billing Errors Crucial During ICD-10 Transition

ICD10 pictureErrors in medical billing are a serious problem in healthcare today. By some estimates, as many as 80 percent of all submitted bills contain some sort of error, which leads to increased costs for Medicare, insurance carriers and patients, but can also lead to coverage denials, reduced reimbursements for providers, and in some cases, impacts on patient care.

While many organizations have placed a priority on avoiding billing errors, they still occur. And with the upcoming transition to ICD-10, home health and hospice providers are under even more pressure to get billing right the first time, every time. By most accounts, providers can expect to see a spike in rejected claims during the first few months of ICD-10 implementation; some estimate that as many as 10 percent of all claims will be rejected as coders get used to the new procedures. That’s bound to have an effect on payments and cash flow, so it’s vital that agencies work with their billing offices to identify common errors now, and look for ways to overcome them.

Preparing for the Transition

Ideally, home health agencies should be in the final stages of preparing for the launch of ICD-10 now. August 3 marked the beginning of the 60-day episode period that would end on October 1, when ICD-10 goes into effect. This means that agencies that are beginning care episodes now are required to submit RAPs in ICD-9, but code them in both ICD-9 and ICD-10, so that when the final bill is submitted to Medicare, it will be in the correct format. In many ways, this gives home health providers an advantage, since they will have two months’ worth of practice with the new codes on almost every chart, where most other providers are only practicing dual coding on some charts.

Because of the dual coding requirements, most home health providers have already switched to an ICD-10 compliant software solution. Now is the time to identify gaps in training, and adjust intake procedures, forms and other resources that affect how services are billed. Mitigating potential obstacles now will prevent denied claims later, and smooth the transition.

The Most Common Errors

While the new coding procedures will undoubtedly be a learning curve for many providers, you can reduce the overall number of denied or delayed claims by paying close attention to the most common errors and taking steps to avoid them. These include:

CMS has issued guidance stating that Medicare claims submitted with incorrect codes won’t be denied for the first year of ICD-10, if the codes submitted are within the correct code family. While this does provide some relief of the pressure on coding departments, it’s still important to get the billing right and transition into the new codes as quickly as possible.

If you find the number of rejected claims is increasing, audit those claims to determine where the problems are coming from and take corrective action. When you do, you can reduce the potentially damaging effects of reduced cash flow, decreased productivity, and restrictions on patient care.

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