Patient Access will play a critical role in offsetting the anticipated increase in claims denials when ICD-10 goes into effect in October. With the Centers for Medicare & Medicaid Services (CMS) predicting a major increase in claims denials, possibly up to 200%, hospitals must act now to implement a denials prevention solution before October.
Hospitals have traditionally focused on managing claims denials, but it is now imperative they focus on preventing them. By putting a denials prevention system in place, hospitals can reduce their current front-end related denials (90% of which might be preventable), reduce rework, and free up resources to focus on the ICD-10 related denials that will be upon us soon. Additionally, medical necessity denials can be prevented prior to patient service using an ICD-10 ready automated system that audits physician orders against all payer rules and allows manual validation checks as needed.