Worried About Medicare Claim Denials? Check Out How Our SaaS Medicare Claims Editing Tool Can Assist You

In order to control healthcare costs and ensure satisfaction among employers and providers, payers are crucial. ‌Their goal is to process medicare claims as precisely and efficiently as possible to balance these competing objectives.

Increasing healthcare costs and stagnant profits mean payers have to make sure medicare claims processing is smooth. ‌If you make any mistakes with claims processing, it can lead to a series of expensive problems like inaccurate and inconsistent evaluation of claims, penalties for non-compliance with regulations, unnecessary overhead, and litigation costs.

A Look at How Medicare Claims are Processed:

• Clearinghouses edit medicare claims before they’re approved
• Claim data is aggregated by organizations
• The CMS medicare policy rate schedules are used to ensure clean claims

If multiple specialists submit charges on a single hospital claim, the aim is to ensure accuracy and limit overpayments or underpayments.

Payers Can Face a Variety of Challenges

In the event that edits to a medicare claim result in overpayments or underpayments, claims are denied and investigated further. ‌A failure to substantiate edits could put payers at risk of costly appeals and litigation. Providers will ask about the reason for edits. ‌Health plans are often forced to reopen claim appeals, pay physicians for previously denied claims, and update their systems to provide transparency regarding the sources of rule details and appeals procedures due to legal challenges. To ensure that everyone is satisfied that they are being treated fairly, it’s simply a good practice to remain transparent when editing sources.

Is There a Solution?

In the past, vendors offering Medicare claim editing competed by offering proprietary edits based on their interpretations of the codes. ‌In light of the increasing demand for standards and accountability, today’s best practice is to use CMS editing tools to clearly document, comply and explain edits in language that providers can understand.

CMSPricer: Why Should You Use It?

We offer an affordable medicare claims editing solution that analyzes a claim, identifies edits if needed, and provides fast, efficient, and accurate results. ‌

With CMSPricer, you can increase the first-pass through‌ ‌rate‌ ‌for‌ ‌claims‌ ‌when‌ ‌working‌ ‌the‌ ‌revenue‌ ‌cycle. ‌Changing CMS rules, coding complexity, and regulatory changes have made this increasingly difficult. Additionally, these rules and regulations are continually evolving. ‌As a result of these changes and regulations, you need an automated process to validate your claims before they’re generated and sent to payers, like CMSPricer’s editing service, which is fully automated via a web service.

Here’s what we can do for you.

• Age edits
• RVU edits
• CPT edits
• Gender edits
• Modifier edits
• Correct code initiatives
• Diagnosis claims validation
• Outpatient code edits (IOCE)
• Local coverage determination (LCD)
• National coverage determination (NCD)

Designed to work fast, scale to its optimum use, and customize configurations to switch “on/off” specific edits whenever necessary, CMSPricer’s Medicare claims editing interface is launched with an edit-only approach. SaaS-based ‌CMSPricer’s portal includes a user-friendly and easy-to-manage configuration tool.

Interested in how CMSPricer’s medicare claims editor‌ ‌works? ‌Try CMSPricer’s 5 medicare claim editing for free! CMSPricer is offering new users this option before you become its users!