It
can get frustrating when claims are denied, but if the incident keeps occurring
in your healthcare facility or organization, you may want to take a look at
your processes and the way they are handled in your office. Timing issues,
errors, and input oversights are among the reasons why some claims are denied.
By being mindful of these incidents and following HCC medical coding standards,
you could minimize denials and improve your approach to billing.
Hierarchical
condition category (HCC) and risk adjustment coding is the payment model that
identifies patients with chronic or serious illnesses, then designates a risk
factor score to them according to factors like demographic details and health
conditions. HCC medical coding was implemented in 2003 and mandated by the
Centers for Medicare and Medicaid Services (CMS) in 1997. A patient’s health
condition is identified using ICD-10 (International Classification of
Diseases-10) diagnoses, which you submit to insurance companies when filing a
claim. There are over 9,000 ICD-10 codes being mapped to 79 HCC codes.
HCC
medical coding errors are among the reasons why claims are denied. By working
with a seasoned team of AAPC-certified medical coders, you could minimize those
mistakes and increase the accuracy of your claims. All coding must be audited
before the charts are finalized. Claim denials may
also occur when
the claim is not up to the insurance company’s standards. So, you need to make sure that the claims are
made according to their regulations and that they are legible, specific, and
complete with all the information required.
Missing
information is another reason why a claim can be denied. Even a small detail
left out can cause problems later on, especially when you are dealing with a
detail-oriented insurance company. Keep in mind that some payers will look for
minor specifics, such as the date of the medical emergency, onset, and the
accident. A claim can be denied if it is not filed on time. Some providers of
HCC medical coding services have a team of specialists who will make sure that
the claims are submitted on time.
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