In our recent webinar, How The MetroHealth System reduced denials with value sets and improved coding, Dr. Peter Greco, Director of Informatics, and Eric Cercone, Director of Patient Financial Services at MetroHealth, discussed how integrating IMO Health’s coding assistance value sets into their electronic health record (EHR) improved data quality and reduced the burden of correcting and resubmitting denied claims. They also revealed how other organizations could replicate their success.
In a hurry? Continue scrolling for a few clips and excerpts from this session.
Navigating the claims-denial cycle
Certain codes, like external cause and manifestation codes, are valuable for clinicians to document but cannot be sent for reimbursement as primary diagnoses. Yet, clinicians still use them, leading to claim denials.
How can you avoid this denial cycle?
Thinking through the problem
As payers adopt more stringent policies around reimbursement for unspecified and primary diagnoses, organizations like MetroHealth are seeking solutions to avoid claim denials. This allows them to avoid having unnecessary post-service work by coders or follow-up staff to work through the denials. In turn, clinical workflows become optimized.
MetroHealth wanted a tangible solution that would inform providers at the point of care that their documentation was going to be denied by the payer.
Brainstorm a solution to streamline clinical workflows
The core question is: How can organizations effectively identify problems that can’t be primary diagnoses or don’t specify laterality, and how do they fix them?
- Organizations need a list of unacceptable primary diagnoses and diagnoses that don’t specify laterality
- They must check primary diagnosis codes and specificity before clinicians close their encounters
- If they find a problem, they must inform the user of what’s wrong and how to fix it
Of course, this is easier said than done.
The key: Administrative coding assistance sets
The solution for MetroHealth was implementing administrative coding assistance sets to flag non-primary codes and unspecified codes upstream.
This solution enables clinicians to catch potential claims issues at the point of care, long before submitting the claim for reimbursement.
a 10x ROI with IMO Health’s administrative coding solution
