Coding Case Study 2
Problem Statement
Increased denial rate due to inappropriate coding by in-house team
Project Objective
To reduce the denials and increase the clean claim percentage for better reimbursement
Root Cause Analysis
After a detailed study, we identified the below listed challenges which caused the denials
Improper usage of Modifiers, Diagnosis pointers
Payor specifications not applied in the initial phase of coding
Inappropriate usage of POS for telephone and Telehealth visits
Solutions Provided
Reduced the denials by implementing the below listed denial solutions
Payable Diagnosis
LCD & NCD Guidelines
Provider Eligibility
POS (especially for Telephone & Telehealth services)
Gender associated procedures & diagnosis
Correct usage of modifiers by applying CCI concepts
Payer policies on CPT, DX & Modifiers
Results Shown
Reduced the coding related denial percentage by 50% in the first 45 days which accelerates cash-flow
Reduced cost & efforts on appeals & corrected claims
Reduced AR days by 20%
Assisted providers with the documentation improvement