Gone in Sixty Seconds, What Do I Do Now???
Gone in Sixty Seconds, What Do I Do Now???
Changes in coding and reimbursement rules can occur often and in a flash. The existing complexities of the claim submission stage of revenue cycle management will soon have yet another layer. April 1st, 2022 brought a new Medicare Code Edit (MCE) 20, unspecified code; an ill-considered, unprepared approach to this intruder will significantly impact your revenue and reimbursement. MCE 20 will trigger when an unspecified code(s) has been submitted on an inpatient claim, in turn, the claim error will be reported; effective with discharges April 1, 2022 and after.
Always, but especially now, it is essential to enforce the practice of submitting clean, concisely coded claims that exclude unspecified codes. Here are a few suggested ways to help facilitate change and form a foundation.
- Alert and Inform your Revenue Cycle Team about MCE 20. It is important for every stage to have the knowledge and also focus on documentation from patient registration through receipt of reimbursement
- Re-introduce and Educate providers on the importance of detailed, specific documentation. Focus on types, sites, and laterality for conditions in all body systems. Implement and/or Enhance a provider query process
- Enact a policy requiring second level review of assigned unspecified codes. Conduct internal and/or external coding audits centered on unspecified ICD-10-CM codes and identifying clinical documentation improvement opportunities
- Engage with or Establish a team of individuals dedicated to resolve identified unspecified codes
- Present examples of any insurance denials for unspecified codes to help emphasize the main objective.
CMS finalizing the new MCE 20 edit is a preview and strong indication that 3,432 unspecified codes currently designated as MCC/CC, may be deleted in the future; inducing an unsettling financial collision. As healthcare transitions to value-based care reimbursement, be proactive and Calibrate each stage of the revenue cycle to Boost chances of optimal payment!
Mashallis Andrews, RHIA, CCS, CCS-P
Director of Consulting Services