Medical Billers and Coders

  Increasing Claim Denials Recently Kaiser Family Foundation published an analysis of claim denials for various marketplace payers for the year 2020. Under the Affordable Care Act, marketplace payers need to report claims denial data and this analysis used the same data to understand claim denial status. The analysis found that, overall, nearly one out of every five claims submitted for in-network services in 2020 was denied by marketplace payers. However, depending on the payer, average claim denial rates ranged from just 1 percent to 80 percent. Claim denial rates also varied significantly by location, the average claim denial rates were highest in states such as Indiana (29 percent) and Mississippi (29 percent), while rates were just 6 percent in South Dakota and 7 percent in Oregon. This analysis just confirmed ever-increasing claim denials for healthcare providers. Claim Denial Reason Payers denied claims for multiple reasons, among denials for in-network services, about ...

Determining anatomical location and laterality needed by ICD-10 is simpler than you might suspect. This detail reflects how physicians and clinicians communicate and what they focus on – it involves guaranteeing the data is caught in your documentation. In ICD-10-CM, there are three fundamental classes of changes Definition Change; Terminology Differences; Increased Specificity. For cardiology, the center is increased specificity and documenting the downstream impacts of the patient's condition. Acute Myocardial Infarction (AMI) When documenting AMI, include the following: Timeframe An AMI is now considered “acute” for 4 weeks from the time of the incident, a revised timeframe from the current ICD-9 period of 8 weeks. Episode of care ICD-10 does not capture the episode of care (e.g. initial, subsequent, sequelae). Subsequent AMI ICD-10 allows coding of a new MI that occurs during the 4 weeks “acute period” of the original AMI. (ICD-10 Code Examples: I21.02; I21.4; I22.1) Hyper...