While challenging, the importance of keeping up with changes to Medicare coding and claims processing cannot be overstated. Inaccurate or suboptimal coding of diagnoses and treatments results in missed reimbursement opportunities — which allow hospitals only a short time to correct and claim. And, unfortunately, because of the additional complexity associated with ICD-10 and the manual nature of coding, it’s crucial for hospitals to have procedures in place for comprehensive coding reviews.
The three strategies below can help hospitals continually improve their practices and prevent lost reimbursements:
1. Implement technology to optimize Medicare reimbursement
Better technologies allow for deeper and more dynamic auditing of data and more thorough reviewing, which helps hospitals receive full reimbursements. Given the tight deadlines and large volumes of data involved in these reviews, hospitals should consider visibility and speed as top priorities when choosing new technologies to manage Medicare reimbursement.
2. Evaluate coding consistently to identify missed revenue
Since ICD-10 coding is significantly more complex than ICD-9, consistency in reviewing coding is critical. Taking frequent, retrospective looks at coding assignments helps identify any potential deficiencies or inaccuracies within the allowed re-billing time period. Without at least monthly audits, hospitals run the risk of identifying problems only after it’s too late to claim a missed reimbursement.
3. Stay ahead of tight Medicare auditing deadlines
If you do identify a problem with coding shortly after it’s billed, the pressure’s on to resolve it as quickly as possible. Medicare requires that hospitals submit corrections to claims within a specified amount of time; most hospitals have roughly 60 days from when the original bill was dropped to go back and make changes to the claim.
TransUnion Healthcare provides hospital revenue cycle analytics that enable hospitals to identify their top reimbursement issues, find missed revenue quickly and avoid future underpayments by getting claims right the first time they’re filed. Learn more about our specialized Medicare reimbursement solutions.