A sure way to eliminate costs related to bad claims is to make sure they’re as clean and compliant as possible before they reach the payer. Incorrectly coded claims create waste – from processing, to follow up to managing appeals. It all adds up to higher administrative costs and increased A/R days.
Many clearinghouses offer a basic claim scrub before submitting professional and institutional claims. But a cutting-edge clearinghouse will include an advanced claim edits feature that helps to push what would otherwise be denied claims back to your team to fix before they get denied. This preventative feature helps reduce overall costs associated with manual re-work, claim resubmission, appeal management and follow up between your office and the payer.
Think of an advanced claim editor as extra claims scrubbing that looks for specific things like lack of or insufficient documentation, medical necessity, appropriate use of modifiers and incorrect coding.
With advanced claim edits in your clearinghouse, your entire claims cycle will improve:
- Increase first-pass claim rate
- Decrease denials
- Improve cash flow/reduce A/R days
- Increase workflow efficiency
- Decrease potential inaccurate, duplicate or reduced payment
- Improved staff productivity = more time to focus on patient care
Embracing this technology fully arms providers to combat the constant moving targets within payer claim rules and regulations. Providers that implement advanced claim edit features to their claim submission process rarely look back, as the many benefits and gained savings far outweigh the cost.