Coding Case Study 2

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