title: The complexity and value of mid-level patterns of denials.
abstract: Finding patterns in denied claims makes the task of correcting and resubmitting them far more efficient. But ICD-10 exacerbates the problem. As use of ICD-10 grows, it will: Increase the number of codes substantially, increasing the granularity of data being captured about each claim, and combinatorial complexity will explode. Alter both payer and provider behavior, blowing away carefully cultivated pockets of tribal knowledge. Significantly challenge any method that uses the hierarchy or heuristics of existing code sets, rendering many software stopgaps useless. Spread codes far more broadly for a given procedure, making patterns far more difficult to detect using traditional analytics.
authors.forename: Allison
authors.initials: A
authors.lastname: Gilmore
mesh_terms: D059019:Clinical Coding; D004469:Economics, Hospital; D007344:Insurance Claim Reporting; D007345:Insurance Claim Review; D007349:Insurance, Health, Reimbursement / Q000191:economics*