Month: October 2015

How to Reduce ICD-10 Denials

October 16, 2015 Posted on Categories Billing Service, ICD-10

by Michelle Tohill

As you well know, ICD-10 went into effect Oct. 1. Many of you are already submitting claims using the new coding system. In the next few weeks, you’ll find out how well you’re doing based on the number of successful reimbursements compared to rejections.

Avoid costly delays and irritation by following these five steps to reduce ICD-10 claim denials:film Despicable Me 3

1. Review/work claim rejections daily
With the new standards, it’s important to review and work your rejections on a  daily basis. This is good practice regardless of the situation, but with so much change in the system, it is more important than ever to stay on top of your claims.

2. Documentation is essential
Now is the time to make sure that your documentation is completely buttoned up so that you can justify every claim and also quickly correct any errors that you make that result in claim rejection.

3. Education & knowledge on ICD-10 medical billing standards
Hopefully you have good billing software and a billing team that is helping through this transition, but even the best systems and software can’t beat taking the time to really learn the new ICD-10 coding system to reduce errors and eliminate rejections.

4. Avoid using the “Unspecified” ICD-10 codes
This is a red flag, and will likely result in claim denial. If you absolutely must code with an “unspecified” code, provide needed detail associated with the ICD-10 and documentation aiding in meeting medical necessity.

5. Become familiar with the LCD guidelines
Local coverage determination (LCD) guidelines vary from region to region, making it critical that your medical billing software and billing team are familiar with which region applies to the specific care being claimed. Not following LCD guidelines will result in unequivocal claim denial.

Most of these tips are things I recommended before Oct. 1, but now they are even more important. At Bonafide, our software-only customers have the benefit of utilizing our updated software. Of course, our billing customers have the added benefit of our expert team of billers. Let us know if you need some help reducing your medical billing claims!


Michelle Tohill is Director of Revenue Cycle Management of Bonafide Management Systems and oversees all billing programs and processes. Her specialty is conducting AR audits to expose inefficient billing practices that fail to fully reimburse physicians for their work. She conducts AR audits and provides Bonafide customers with training and consulting on how to improve every aspect of billing and practice management to maximize revenue.

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