Cost constraints often hinder facilities from attaining the most sophisticated scrubbing platforms to ensure minimal error rates and billing efficiencies. Staff attrition can also create deficiencies in an atmosphere that continues to grow in complexity. And lastly, carriers are always at risk in adjudicating claims correctly against fee schedules and more. Errors arise from human deficiencies but also from numerous platforms that have been built on top of one another and do not always sync appropriately. For these reasons, facilities should consider auditing their current billing and clearinghouse functions at least annually. We not only provide robust reporting on our findings but reprocess corrected claims for added revenue!
Big Data Analytics
Our Electronic Data Interface can oftentimes deliver 5% or more in claims recovery over your existing platform and current capacities. Our proprietary clinical “medical necessity” database more than doubles the number of CPT® codes in Medicare LCDs/NCDs to cover virtually all possible ICD-9/CPT® code combinations.
Additionally, our platform:
• Stores 11 million edits to maximize your claim reimbursements.
• Edits are regularly updated to keep up with ever-changing rules and regulations.
• Correct Coding Initiative (CCI) edits, which include over 700,000 CCI (bundling) edits.
Common Error Codes:
• Invalid DRG
• Invalid NPI
• Invalid Modifier code
• CCI mutually exclusive edit
• E/m missing modifier 57
• Invalid procedure code
• Diagnosis Secondary only…
• Units greater than MUE maximum…
• Invalid procedure code for medicare
• Procedure inappropriate for LD modifier
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