How Prior Authorization has been helped by ICD-10?

NEW YORK - Dec. 21, 2017 - PRLog -- There's a huge difference in the prior authorization scenario before the advent of ICD-10 and post ICD-10. The 10th revision of the International Statistical Classification of Diseases and Related Health Problems, ICD-10 has to be a key factor in reducing errors in prior authorization processing to a large extent. A medical classification listed by World Health Organization (WHO), ICD-10 is the classified list of codes for different diagnosis, reasons, causes, findings, complaints etc. for diseases, injuries, procedures, etc. As prior authorization is now completely based on procedural and medicinal codes, ICD-10 has bridged the gaps left in terms of covering more and more medical requirements. ICD-10 has come as a jolt in fighting errors in prior authorization and claim settlement.  It is a great weapon to streamline the prior authorization process and encourage more successful prior auth approvals from the insurance companies. Prior authorization is an integral part of the patient-provider-payer cycle and accuracy level in coding is an absolute necessity in this current scenario. The implementation of ICD-10 has definitely given the scope to the practice managers to relax a bit but they should be alert to certain implications of the new beginning:

• Importance of Diagnosis Code: The Diagnosis codes constitute the most important part of prior authorization request approvals. The implementation of ICD-10 is surely going to increase the use of diagnosis codes henceforth.

• Monitor Procedure Code: The matching of the submitted ICD-10 codes with the requested procedure codes is an absolute requirement to avoid denials of requests.

• Emphasis in Training: Training of the prior auth executives have become an urgent requirement as they need to be updated with the new procedures, associated codes, and the technicalities involved.

• Gathering Additional Information: Under the ICD-10, Providers and/or their prior auth requestors must gather more information regarding the patient and the procedure. The information required in the existing manual process or the last code implementation is not sufficient now.

• Upgrading Medical Coders: Medical coders need to upgrade themselves for the purpose of submission of correct diagnosis codes.

With these checks and balances, ICD-10 migration is definitely helping prior authorization in the long run. However, with all these requisites, payers' pressure will be immense on the providers. The in-house staffs who are already over burdened will bear the brunt of even extra work and would need more alertness. In this scenario, an expert yet economical respite in the form of professional prior authorization services can help fulfill the real aim.

Source: https://priorauthonline.com