GREENWOOD, Ind., Oct. 10, 2016 /PRNewswire/ -- On October 1, 2016 CMS ended the one year ICD-10 flexibility period. If providers now submit claims with unspecified codes when other, more specific, codes are available, CMS review contractors can deny their claims. If providers continually submit inaccurate codes, it can be a red flag which in turn can lead to an audit. To avoid being audited, CMS recommends that providers "code claims to the degree of specificity supported by the encounter and the medical documentation." AmeriVeri (http://www.ameriveri.com), a provider of enhanced medical code verification services, helps affected parties meet these requirements, assuring the highest level of medical code specificity, and leading to more accurate patient histories.
This enhanced level of code specificity affects the collection of accurate and complete coded data, and is critical to such areas as healthcare delivery, public reporting, research, reimbursement, and policy making. Ensuring the integrity of coded data and the ability to convert the raw data into functional information requires that all official coding rules, conventions, guidelines, and definitions are consistently applied and updated. The use of uniform coding standards reduces costs, enhances data quality and integrity, and improves decision making, which leads to higher quality healthcare delivery and information.
AmeriVeri's experience and research indicates the rate of unspecified code use today is at 31.5%. The goals of increasing code specificity are to improve health outcomes and to reign in the cost of healthcare in America. While the migration to ICD-10 and the demand for increased granularity has required a significant upfront investment, the payoff is expected to be substantial.
"A recent report provided to a workers' compensation insurance client demonstrates the tremendous value of our process," says AmeriVeri VP of Operations Martin Amberger. The report verified that nearly 800,000 claim lines were processed representing a total of $154 million. Errors were identified in 69,685 claim lines – a rate of about 11%. AmeriVeri has potentially saved this client more than $13 million."
"Moreover, ICD-10 code specificity is just one aspect of the AmeriVeri verification service. We also provide a host of edits that collectively guarantee a high level of code accuracy."
In the column of descriptions of why lines are marked as errors, a few items stand out. For instance, "Invalid DX Code" accounted for a big percentage of all errors and occurred at a relatively high rate. Similarly, the "Medical Necessity" edit – a proprietary component of AmeriVeri's review system – contributed to $2.7 million of the $13 million in total savings. Both of these descriptors correlate to unspecified or insufficient ICD-10 codes.
AmeriVeri's value proposition is that its code verification system averages finding 3 errors per hundred lines of code – even after claims have passed through adjudication software processes.
The end of the ICD-10 unspecified codes grace period is not the only change that providers and payers are seeing this year. Nearly 2,000 new diagnostic codes will be added to the manual. Additions and revisions happen every year, but this year's conjunction with the end of the grace period creates a double challenge.
Providers who are slow to adopt the new ICD-10 standards are likely to see their revenue trend downward. Alternate payment models based on patient outcomes will demand more specific codes. Therefore, the time to understand and implement these specificity rules is now. AmeriVeri enables a virtually seamless transition for both providers and payers.
"Looking ahead, accurate and precise medical coding will continue to be a vital part of guaranteeing quality of care for patients, and cost savings for payers," concludes Amberger. "From a broader perspective, consistent coding practices are essential for planners and researchers looking to improve access to healthcare and identify areas where more investment may be needed. AmeriVeri helps make all of this possible, without adding complexity."
About AmeriVeri CR, LLC
AmeriVeri was founded in 2010. The company is privately held with offices located in Greenwood, IN, and Denver, CO, and affiliates in Chicago, Minneapolis, St Louis, Columbus, Cincinnati, Atlanta, and Dallas, providing nationwide enhanced medical code verification services in the Major Medical, Workers' Comp and Medicaid arenas.
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