Errors 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:
- Accurate patient information. Often, claims are denied because of clerical errors in patient information. Double check that all information is correct and in the right location. In addition, establish policies regarding physician referrals that ensure that you have the level of detail required by ICD-10 in your records. Adjust processes so that you have adequate personal and health histories and discharge summaries on patients being referred for home health.
- Use correct codes. It might seem easier said than done, especially with the new system, but using old or invalid codes will result in rejections. Start training on the new codes now, and increase staff or outsource medical billing during the transition to compensate for slowdowns in productivity while coders get used to the new standards.
- Check dates. Overlapping service dates are a leading cause of home health claim denials. Patients who are in hospice can receive home health services at the same time, but for patients who are not in hospice, Medicare only allows episodes from one provider at a time. When submitting your RAPs and final bills, make sure that the start date of your services does not overlap the end date of services from another provider. Check the patient’s Medicare eligibility to determine the discharge date from the previous provider to keep your claim from being denied.
- Confirm physician and NPI numbers. Missing or incorrect information will delay claims.
- Conduct regular chart audits. Confirm that you are only billing for services once, and not billing for services that didn’t take place. There have been cases in which claims are submitted for services that were rescheduled or cancelled, so commit to regular checks to ensure that only those services that actually took place are being billed, and that they are only being billed once.
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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