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ICD Transition:  Working With Your Referral Partners On Dual Coding

Don't wait until the last minute to discuss ICD-10 with your referral partners.

A good ICD-10 communication plan includes direct coordination with referral partners. Contacting your referral partners in January will allow you to start building an ICD-10 networking group for sharing information on payer readiness, vendor options and staff training and the information you mine from your referrals may continue to boost your financial performance even beyond the initial implementation date through stronger ties with referral partners.

In order to jump start your referral partner communications, we are providing the following letter which you can customize to suit your ICD-10 communication plan.  Further, an effective ICD-10 communication plan also requires that this type of letter be assigned to an ICD-10 team member to monitor referral responses, respond promptly to referral inquires and make related updates to the implementation plan and procedures.

Dear Referral Partner,

Thank you for your history of referrals to our office.  We are constantly seeking to improve our coordination of care practices and we hope that your patients have been well served by our clinical partnership.

We would like to keep you informed regarding our ICD-10 implementation efforts that may impact our mutual patients.  In order to prepare for the ICD-10 implementation date, we have a number of specific objectives in the coming months which may impact the documentation we share regarding patient care.  Please note the following dates and/or requested items:

(Customize the following bullet points to your specific ICD-10 requests related to the referral source)

• In order to prepare for ICD-10, we request that your patient communications reference both the ICD-9 and ICD-10 code(s) for each patient beginning on (date).  This dual coding will allow us to more effectively prepare billing staff and negotiate with payers regarding the upcoming code changes.

• We are conducting ICD-10 internal or external testing on (dates).  We request that your referral documentation reference both ICD-9 and ICD-10 during this testing period so we may utilize the testing period to concurrently review our referral communications for ICD-10 compliance.

• We have identified the following high volume diagnoses codes which impact our mutual patients.  To assist with our ICD-10 education and auditing process, we request that your office review these specific codes and provide any guidance you have developed regarding how these ICD-9 codes will be documented and coded after the ICD-10 implementation dates.  Specifically, if your organization is conducting auditing and/or training which identifies which ICD-10 codes will likely be utilized for these high volume ICD-9 codes, please provide us with any information regarding forecasted ICD-10 code usage.

Thank you in advance for any assistance you can provide regarding these items.  Again, we are committed to providing your patients with the highest care possible and want to ensure that patient satisfaction remains high during the ICD-10 transitional phase.  If you wish to discuss your ICD-10 needs or concerns, please contact our office.  We look forward to discussing ICD-10 with you at your convenience.

Sincerely,

Download more Appeal Letters at AppealLettersOnline.com

AppealLettersOnline.com Featured Letters

We are currently working on our ICD-10 Appeal Letter Collection scheduled for release in the second quarter of 2014. The following is a list of the appeal letter titles which are under development for inclusion in the ICD-10 letter collection:

• Coding Level I - submission of supporting docs on ICD-10 coding selection choice
• Coding Level II - demand for payer transparency regarding ICD-10 selection
• Coding - Physician/Hospital ICD-10 Coding Mismatch
• Coding - claim denied based on specificity when clinical documentation supports the unspecified code only
• Medical Necessity Level I - submission of clinical documentation supporting ICD-10 code selection
• Medical Necessity Level II - demand for payer transparency regarding ICD-10 medical necessity denial
• Duplicate - lack of payer response to initial claim
• Duplicate - lack of payer response to corrected ICD-10 updated claim
• Precertification - precertification not obtained due to inability to verify payers ICD-10 codes requiring approval
• Precertification - precertification requested but not obtained due to payers lack of response
• Precertification - precertification denied due to medical necessity with payer failing to provide a peer review of the decision
• Precertification - Precert/Billed Claim ICD-10 Coding Mismatch
• ICD-10 Payment calculation inquiry based on variance from ICD-9 payment
• Coordination of Benefits
• Other Exclusion/Limitation
• Corrected claim based on Payer-specific Requirements
• Corrected claim based on updated clinical documentation
• Corrected claim based on updated patient information
• ICD-10 contract language appeal - prompt payment
• ICD-10 contract language appeal - verification
• ICD-10 contract language appeal - outliers
• ICD-10 contract language appeal - coding transparency
• ICD-10 contract language appeal - medical necessity review requirements

If your organization has identified ICD-10 denial issues, please let us know specifically which types of denials you anticipate.  We will be happy to share with you if one of our letters would be appropriate for the denial or if our letter collection needs to be expanded to include the identified denial.  Contact Tammy Tipton at t.tipton@appealsolutions.com with any questions related to the ICD-10 Appeal Letter Collection.

Access the appeal letters at AppealLettersOnline.com

Customized ICD-10 Denial Management

ICD-10 denial management is a key feature to a successful implementation plan.  Appeal Solutions is currently offering customized ICD-10 denial management staff training focused on denial avoidance as well as successful appeals.

Appeal Solutions provides onsite training specific to ICD-10 denial management.  This 3-hour training session can be presented onsite or via webinar and is customized to address your organization's training needs.  Topics include:

• Denial avoidance - Get your verification and precertification staff ready for ICD-10 implementation.  We provide training on verification and precert best practices and numerous payer-specific resources for situations where payers do not follow national performance standards in quality verification and precertification responses.
• ICD-10 Appeals - Denials will be unavoidable.  Make sure your ICD-10 appeals are effective and that your staff understands their rights to complete transparency regarding the payer's coding and clinical documentation denials.  Further, we provide review and recommendations regarding your ICD-10 denial identification procedures to make sure that no appeals are rejected as "beyond the time frame for appeal."
• Address poor quality ICD-10 appeal review - you have the right to high quality appeal review.  We provide letters which cite legal information regarding appeal review.

Don't wait until fall to schedule training!  Contact Tammy Tipton at t.tipton@appealsolutions.com to schedule a customized training day for January through April and begin working early with payers and referral partners to insure your organization's successful implementation.

Access the appeal letters at AppealLettersOnline.com