Claim Edits/ Rejections
Claim editing is a cost-effective solution in healthcare RCM to ensure accurate medical billing and to protect patients from unnecessary bills.
Content
Intro
Medical procedures performed and recorded by the health care service provider is transformed to codes by professional coders as per the international coding standards. This is done before the claims are submitted to the insurance company. BIS provides professional medical coding services that improve the overall medical billing process effectively by reducing claim process timing and denials.
The codes form the crucial part of the claim that is being submitted. Hence utmost care should be taken while coding, as errors increase denials and the turnaround time in processing the claim.
Coded documents/charts being the crux and the sole record for the claim processing by insurance eligibility verification services, healthcare coding becomes a very critical and sensitive process. Thus, the role of medical coding companies become vital and significant in the boosting up the cash flow of the healthcare institutions.
Healthcare Medical-Coding Process Flow at BIS
1. We Business Integrity Services access the healthcare management’s system in a secured and authorized manner to gain access to the medical records.
2. The documented medical records of the patient including the diagnosis, tests and their reports, doctors’ transcript notes, audios, etc. are carefully gone through to verify and validate the correctness of information, at the pre-coding stage. This step confirms that the entire medical records are available, and no records are missed out.
3. Our experienced medical coders holding a lot of responsibility, assign codes for the complete medical procedure starting from diagnosis to the patient discharge. Coding is done as per the defined international standards in ICD and CPT. While assigning codes, our expert coding team ensures that there is no information missed out and the medical coding is done to the highest level of specificity. Few of the common checks that our team look out are linking right codes to the CPT, up-coding, and down-coding errors, not using invalid codes deleted during the yearly updates.
4. In line with the principle of maker-checker, our QA team which comprises of senior coders conduct multiple quality checks and audit the healthcare coding at the previous stage. These audits serve as a baseline pointer for coding accuracy. Also, the quality team in their root-cause approach, meticulously reviews the process gaps and failure modes in each of the stages to prevent and arrest any such challenges re-occurring, thus improving the healthcare coding process efficiency.
5. After the quality audit stage, these coded documents/charts are shared with the client for their feedback and response.
6. Upon receiving the feedback for any nuances, necessary changes are done in the coding. Thus, a cohesion is arrived between the client and us which affirms the medical services rendered and their respective coding.
Advantages Of Choosing BIS For Outsourcing Medical Coding
• Experienced medical billing and coding team.
• Inhouse medical coding training team to conduct regular training and refreshers to the team to stay on top of the latest and updated developments in the coding standards.
• Efficient quality check team to consistently bridge the process gaps and build a robust coding framework to provide error-free coding.
• Higher coding accuracy levels thus reducing the denials.
• Quicker turnaround time for claim process due to minimal denials.
• Expediated claim payments improving the cash flow.