Beginning October 1st, 2015, healthcare providers can expect an increase in claim denials, but revenue will not necessarily be lost. The Centers for Medicare and Medicaid Services predict that denials could increase from 100% to 200% and lengthen accounts receivable (money owed to a company) cycles by an extra 40%.
Larger organizations can save up or get a line of credit in order to sustain periods without reimbursement, but smaller organizations may not be able to do this. Physicians will need to spend more of their time justifying reimbursements that will decrease productivity.
Healthcare providers will need to invest in a denials manager who can track denials and communicate with healthcare payers. Denial managers need to have a strong understanding of the medical billing process and medical concepts, and also recognize why claims are denied so they can correct deficiencies in documentation.
End-to-end testing is essential to identify problems and solve them before they prevent reimbursements. Testing will reduce surprises in denials after October 1st.
Trends must also be recognized in denials, so that providers can understand how to submit medical claims properly. The following should always be tracked: days in accounts receivable by healthcare payer, denial rates, amount of reimbursements denied, and if reimbursements math the contracted rate. ICD-10 denial management needs to start early in order to identify what may cause problems in the future.