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6 Ways To Prevent ICD-10 Rejection

October 28, 2013

Learn how to avoid ICD-10 rejectionA new problem has been identified that could damage your revenue. It’s called “ICD-10 Rejection.” As the thousands of new diagnosis and treatment codes are rolled out, this issue could potentially wipe out your cash flow.

The Dangers

  • Incorrect–typically lower–reimbursements from payers for health insurance claims.
  • Increased claim denials.
  • Delayed payments.
  • Coder unhappiness and/or confusion.


  • Build up practice cash reserves to combat reduced cash flow.
  • Thoroughly train coding staff.
  • Test new code knowledge retention often.
  • Install checks and balances to improve claim documentation.
  • Prepare, prepare, prepare.

To avoid falling victim to this very real revenue risk, take the following steps to avoid succumbing to the dreaded ICD-10 rejection. Fortunately, you can protect your medical practice from revenue shortfalls if you use these suggestions.

Preventing ICD-10 Rejection

  1. Prepare “clean” claim submissions. Have a staffer proofread all documentation before claim submission. Check all originating documents along with the claim package itself. If entries or codes appear confusing, clarify all data. Don’t depend on payers’ employees to fix errors or make difficult interpretations of conflicting entries.
  2. Be sure your patient information is correct and up to date. Ask patients if any contact or insurance information has changed since their last visit. A busy front desk may cause some challenges, but the extra minute or two will prevent claim rejections and delays.
  3. Employ the best medical billing software available. Be sure your billing software is fully compliant with all regulations, particularly those that have changed since the last update was loaded. Ensure that staff using the software understands it thoroughly. As in tip #1, have another set of eyes double check all output for clarity before pushing the “submit” key.
  4. If claims are delayed or unpaid, explain to your patients the entries on the EOB (Explanation of Benefits) form, as they often lack good understanding. Assuming all patients have in-depth understanding of EOBs is a recipe for problems. Helping them understand why their claims are delayed can spark patients to offer information that solves the processing problem.
  5. Use your practice management software to identify potential revenue and claim rejection issues. Run–and read–your reports, particularly noting the number and percentage of rejected claims. If you see repetitive reasons for denial, immediately try to rectify the obvious problem.
  6. Be sure your billing staff becomes comfortable with ICD-10 codes and payer changes to their claim process procedures. Complete preparation for the many changes to come on October 1, 2015 will help avoid claim rejections and reimbursement delays. Thoroughly training, practice repetition and repeated staff testing, like coaching a sports team, will keep your revenue cycle operating at maximum efficiency.

Similar to the many benefits of preventative medicine, preventing claim problems before they do damage to your cash flow is necessary to avoid revenue shortfalls. If your practice cannot afford to augment, train and test billing staff, consider using a top medical billing firm, such as M-Scribe Technologies, to lift this burden off the practice. The best billing firms will train their staff to understand all of the changes and nuances of the ICD-10 conversion and the up to date processes of most payers.

The benefits are many; the risks almost non-existent. The cost is manageable, possibly a significant savings for the practice. While your internal staff still needs to understand ICD-10 requirements, your billing firm will make every attempt to ensure your claims are billed and submitted accurately.

Even if you decide to use a top third-party billing firm, use the aforementioned 6 tips to ensure your practice does all it can to keep your revenue strong. Delayed reimbursements can inflict damage almost equal to rejected claims. In both situations, revenue will not come in on time.




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