Feb 5, 2014

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Managed Care Contract Language and ICD-10:  Top 6 ICD-10 Contract Readiness Questions

Do your managed care contract agreements protect your organization from poor quality claims processing and appeal review? The answer to this question will grow in importance with this year's ICD-10 coding implementation.

In fact, good contract language can be a key element to ICD-10 survival.

Healthcare billing personnel often view the provider-carrier relationship as an adversarial, often dysfunctional partnership. Unfortunately, improving that relationship is a daunting task. However, ICD-10 implementation presents the opportunity to renew efforts to communicate with payers and seek improvement to the terms that define the partnership.

Keep reading to see the Six Top ICD-10 Contract Readiness Questions

AppealLettersOnline.com Featured Letters

See the following ICD-10 Implementation tools at AppealLettersOnline.com Download Library:

Managed Care Contract Renegotiation Request Letter (Updated for ICD-10!) - This renegotiation request letter has been redesigned to cite ICD-10 implementation as a specific justification for contract review and negotiation.  The letter can be easily edited to name specific contract language you wish to review/negotiate.  Further, the Managed Care Contract Renegotiation letter contains examples of how to cite contract language in appeals so that your negotiation efforts can be more easily enforced post implementation.

Referral Partner ICD-10 Implementation Request Letter - This letter can be used to notify your referral partners regarding upcoming ICD-10 initiatives such as dual coding, ICD-10 testing and/or auditing. The letter is helpful for situations where you want to request dual coding of referral partner communication or seek other ICD-10 input and cooperation.

Physician Notification of Updated Physician Query Procedures (Coming in March!) - Physician query procedures need to be reviewed and updated in anticipation for the ICD-10 impact on physician query volume. Potential changes to the physician query procedures including setting clear deadlines for query responses, new technology deployment for query tracking and a physician escalation policy to notify executive staff of lack of query response.  Look for our article and related Physician Notification letter in next month's newsletter.

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ICD-10 Appeals:  3 Hour Workshop on ICD-10 Denial Impact & Winning Appeals

ICD-10 denial management is critical for a healthy 2014 financial picture.  We are currently offering customized ICD-10 denial management staff training focused on denial avoidance as well as successful appeals so that ICD-10 financial impact is minimized.

We provide both on-site and webinar training specific to ICD-10 denial management. The 3-hour training session can be customized to your needs but typically covers the following:

  • Denial avoidance - Get your verification, precertification and clinical documentation improvement staff ready for ICD-10 implementation.  We provide training on verification and precert best practices and payer performance standards to cite when communicating with payers with pre-treatment claim processing inefficiencies.  Further, we have specific recommendations for CDI programs involving physician query escalation for an excellent query response rate.
  • ICD-10 Appeals - Denials will be unavoidable. Make sure your ICD-10 appeals are effective and that your staff understands how to use payer coding transparency to insure accurate ICD-10 claim edit usage.  Further, we provide 25 appeal letter templates which cite claim processing and appeal protections required by law.  Coding appeals fall in a gray area.  Be ready with ICD-10 appeal letter wording specific to ICD-10 denial issues.
  • Worried about poor quality ICD-10 appeal reviews? We have appeal escalation recommendations that insure your appeal gets prompt attention.  Make sure your payers are compliant with federal and state law regarding denial disclosure and expert-level review.  Now is not the time to seek out readiness assurance from your payers.  Now is the time to prepare to unprepared payers.

The presentation includes 25 appeal letter templates specific to ICD-10 denials.  Don't wait until fall to schedule training!  Contact Tammy Tipton at t.tipton@appealsolutions.com to schedule a customized training day for February through April.

Access the appeal letters at AppealLettersOnline.com

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