ficity of the ICD-10 diagnosis code.
While the goal of ICD-10 was to boost specificity in
claims, the grace period may have instead promulgat-
ed ambiguity. CMS's grace period ends in October.
Many commercial carriers are already denying more
ICD-10 claims. Now's the time to address bad docu-
mentation practices, before they become bad habit. If
your physicians are frequently reporting unspecified
codes, find out why. If you've let your docs know that they need to be
more specific, but they're still providing ambiguous documentation,
show them the financial impact — delayed, denied or inadequate
reimbursement.
What's causing the denials?
If you're seeing denials, you need to pinpoint the cause. The best way
to resolve a problem is to identify why one exists. Start by tracking
and trending the reasons for the denials. These might include:
• Payer processing issue. Review the carrier's remittance advice,
or explanation of benefits, which explain the payment and any
adjustment(s) made to a payment during the carrier's adjudication of
claims.
• Clearinghouse. Ensure all claims batches are successfully trans-
mitted and received. Identify the reports denied upon initial submis-
sion. Why was it denied — due to a system processing error or a code
selection error?
• Provider documentation deficiency. If you notice that your codes
are not specific enough, look to your physicians' documentation. Try
implementing inquiry protocols, when applicable, according to both
the individual organization and state policies. Unspecified code
applications should not be the standard.
J U l y 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 3 5
While the goal of
ICD-10 was to
boost specificity
in claims, the
grace period may
have instead
promulgated
ambiguity.
