In Denial About Denials?

Accurate coding can reduce denials by 90% or more

A recent AHIMA SmartBrief reported, “Medical billing has become so complicated that physicians are forgoing millions of dollars of earned payments. With some 70,000 ICD-10-CM/PCS codes used to identify patient illnesses and injuries, and another 7,000 or so CPT codes to cover medical services and procedures just for outpatient services, along with other requirements to process a bill, it’s increasingly difficult to ensure a bill is accepted and reimbursed in a timely manner… The paperwork to get it right, never mind to appeal, is staggering. By some estimates, insurers deny almost 20% of in-network claims, with many providers experiencing a 30% rejection rate.”

 

MGMA agrees and recently published a study where 69% of those polled reported that claim denials are on the rise. The nearly 600 provider group survey indicated denials are up 17%. Not a 17% denial rate, but a year-over-year on-average increase in denials by 17%.

 

Reducing denials begins with accurate coding, which includes fostering clinical coding versus clerical coding; there is a difference.  Clinical coding is derived from a comprehensive review of the entire medical record, not just identification of ICD-10 or CPT code trigger terms.  Clinical coding includes understanding where to find the details that support HCC, CC and/or MCC assignment, and ensuring accurate reimbursement for care and conditions based upon solid documentation practices. When supported by advanced audit tools that improve accuracy and coder productivity, the return on investment can be significant.

 

AQuity Coding service clients see denial rates under 2% (and yes, we can validate those numbers for anyone looking to improve their performance).  We achieve these low denial rates with our commitment to clinical coding and optimized dynamic coder audits that measurably improve accuracy and productivity, which in turn minimizes production costs.

 

If you are looking to achieve consistently low denial rates, and optimize allowable reimbursements while minimizing production costs, let’s talk.  Our recognition by KLAS as a premier-ranked coding service, and more importantly, consistent service performance and engagement, affirms that our approach works.  Whether our engagements are for limited overflow or full outsourcing, our consultative approach is the same.  We operate as virtual partners in care to help our clients achieve better clinical and financial results.

 

Click here for further details on AQuity’s Clinical coding services. AQUITY CLINICAL CODING

Infographics

Coding denial infographic

Cindy Nicholas, Vice President Coding Services, AQuity Solutions

Cindy is a global healthcare leader with more than 35 years of experience in all aspects of revenue cycle management, patient experience and health information management. Specializing in medical coding, workflow design, quality improvement and healthcare compliance, her ability to develop and lead high performing teams is echoed in her passion for delivering top quality service and impactful results. A credentialed member of AHIMA, Cindy also holds certifications from both the Healthcare Compliance Association (HCCA) and National Association of Healthcare Quality (NAHQ).

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