ICD-10 & No-Fault Insurance

ICD-10 (The International Classification of Diseases, 10th Revision, Clinical Modification) is a revision of the coding system ICD-9-CM, which governs how diseases and injuries are classified and measured. ICD-10 includes roughly 70,000 diagnostic codes, which made their debut on October 1st, 2015.

How ICD-10 Will Affect Medical Bill Collection for Hospitals

Some of these codes could affect no fault billing for hospitals and other medical providers. Two important codes for hospitals to notice are the severity codes and causation codes.

  • ICD-10 Severity Codes
    The ICD-10 severity codes delineate how medical providers and insurance carriers measure the degree of an injury or illness. Under the new codes, carriers may seek to down-code the severity of a specific case by alleging that the records provided and the injury do not match. In short, carriers will attempt to underpay reimbursement by down-coding the severity of the treated condition.
  • ICD-10 Causation Codes
    Like the severity codes, the causation codes give carriers another opportunity to avoid fair reimbursement for no fault accidents and injuries. Under the new codes, government payers or commercial carriers will not reimburse injuries with non-specific and unspecified causation. This includes secondary treatment for accidents, such as chronic arthritis caused by a prior car accident.

Working with a Healthcare Consulting Firm

In New York and New Jersey, no fault laws are designed to make sure commercial insurance carriers pay reimbursement to medical providers for motor vehicle accidents, regardless of liability. With the onset of ICD-10, seeking reimbursement for no fault bills is not only complicated, but problematic.

A healthcare consulting firm can help medical providers determine whether no fault bills merit any recovery through the no fault system. Additionally, a firm can exhaust other possible reimbursement opportunities since payment may involve secondary payers and other options.

Without adjudication of the bill and guidance from a qualified lawyer, exploring these options is difficult, if not impossible.

Work with Russell Friedman & Associates

At Russell Friedman & Associates, our healthcare consulting attorneys serve medical providers throughout New Jersey and New York. We are well versed in no fault medical bill collection and all facets of healthcare consultation.

If your hospital is facing difficulties collecting reimbursement for no fault medical bills, speak with us today by calling (855) 339-4436 and scheduling your first consultation.

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