An Early Warning System for Reducing ICD-10 Claim Denials

Tony BroylesTripp Cox In the recent ICD10monitor article ICD-10 is Risky Business, Holly Louie states that “the best way to fix claim errors is to not make them in the first place.” Since the Oct. 1 implementation of ICD-10 has passed, how will your organization know when and where errors are likely to occur so you can take action beforehand? Predictive analytics can provide the insights necessary to more effectively manage claim denials. Think of it as an early warning system for new patterns of denials and appeals. Early Warning System Many of the claims risk management algorithms currently in use are based on rules learned over decades of experience processing claims coded with ICD-9. With the introduction of ICD-10, these algorithms may not perform as well in detecting problems.…

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