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
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.
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
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.