Health Information Management

Tip: Minimize ICD-10-CM denials by focusing on key performance indicators

APCs Insider, November 13, 2015

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To help minimize the impact ICD-10-CM can have on key performance indicators, start by ensuring you have the right workforce members touching the claims the first time, which may minimize denials and avoid rework. Put your strongest Medicare staff on the denial work as soon as you start to see them.
If you haven't done so already, explore options for hiring backfill coders or other workforce members. This can be costly, but it goes a long way in ensuring claims get out the door sooner.
Analyze documentation to identify trends and patterns in ICD-9-CM that may or may not be carried over to ICD-10-CM. For example, the coding definition of atrial fibrillation may differ from the ways in which providers commonly document it, and this should be communicated to physicians so they can document conditions in a way that will help with accurate code assignment in ICD-10-CM.
This tip is adapted from “Predicting ICD-10 losses and tracking key performance indicators after October 1” in the November issue of Briefings on APCs.

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