Dec 8, 2014

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3 Steps To Specialty Coding Appeal Success:  Put Pressure on Payers to Divulge Specialty Coding Edits

Specialty-care coding edits confuse and confound the most experienced coders. However, challenging a payer's coding determination often results in more confusion, more frustration and a single line of computer-generated insurer-speak such as "paid according to the plan or policy benefits."

Such explanations of benefits are little help and should be viewed as particularly unacceptable to those practices concerned about the upcoming ICD-10 implementation and the likelihood that payer ICD-10 coding edits may greatly impact reimbursement in 2015.

Now is the optimum time to increase your demands that payers provide clear, consistently-applied coding edits so that both sides, payer and provider, understand how benefits are calculated and what coding variables directly affect the reimbursement level. If your payers seem unwilling to explain coding edits upfront, the appeal process provides a way to make a case-specific demand for coding edit disclosure. There are specific legal protections applicable to most payer appeal processes which require the disclosure of detailed information related to coding decisions and your payers adherence to these appeal protections will be especially critical during the ICD-10 implementation process.

As follows are the Appeal Solutions Three Steps to Specialty Coding Appeal Success. Implement this process now and your ICD-10 readiness will benefit from both a better understanding of currently applied edits and a well-established procedure for demanding disclosure and detailed explanations of newly launched coding edits and how they affect reimbursement.

Keep reading to see our 3 Steps To Specialty Coding Appeal Success at AppealLettersOnline.com

AppealLettersOnline.com Featured Letters

We have specialty-specific coding appeal letters for the following areas of Specialty Care:

Anesthesiology, Cardiology, Chiropractic, Dermatology, Endocrinology, Gastroenterology, Mental Nervous/Substance Abuse, Neurology, Ob-gyn, Oncology, Orthopedics, Pediatrics, Reproductive Medicine, Telemedicine

Be sure and review the coding letters under the Specialty Care Topic so that you can appeal coding denials by demanding review by a highly qualified coding professional using specialty-specific coding guidelines.

We are also working on our ICD-10 coding appeals for the specialty-care claims. Please email us if you have any specific specialty-care claims which you believe will be targeting for denial under ICD-10 so that we may include your concerns in our ICD-10 appeal template development. Send comments to t.tipton@appealsolutions.com

Access the appeal letters at AppealLettersOnline.com

ICD-10: The Joke is on Healthcare.  How Many ICD-10 Coders does it take to screw in a light bulb?

Answer: Only one, but the U.S. Congress prefers the dark. 

From the pages of The Wall Street Journal to the debating floor of the US Congress, ICD-10 has gotten its share of laughs. But it is no laughing matter trying to decide what resources to dedicate to the upcoming, uncertain, unfortunately unpredictable Oct. 1, 2015 ICD-10 implementation deadline.

Tammy Tipton, President of Appeal Solutions, has a humorous but helpful presentation on re-energizing your organization's ICD-10 Implementation entitled "ICD-10 Debacle Recovery With A Smile."

Tipton covers the most likely challenges organization face in getting the ICD-10 implementation ball rolling. Highlights include:

  • Five Fun ICD-10 Jokes and using humor to get the ICD-10 Communication Plan back on track.

  • Betting on a Third Delay? What to worry about if you are living in the land of Maybe-It-Won't-Happen.

  • What Payers are Doing and what it means to your organization's ICD-10 investment.

  • Best practices for ICD-10 claims management including how to avoid payment delays and denials and thrive under the ICD-10 cloud of uncertainty.

Contact Tammy Tipton at t.tipton@appealsolutions.com if your chapter is looking for an educational presentation specifically designed to empower providers to protect reimbursement during the ICD-10 implementation. Tipton will also customize a presentation to a specific organization's needs and work with your ICD-10 implementation team to improve denial management in conjunction with ICD-10 implementation.

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