Slash Denials and Capture Revenue: Achieve 98% Clean Claim Rates Instantly

In the relentless pursuit of a healthy revenue cycle, nothing is more frustrating and costly than claim denials. For organizations that handle vast volumes of claims, the difficulty is compounded by the constant complexity of coding, ever-shifting CMS rules, and regulatory updates, changes that can occur daily. The traditional approach of manually chasing down these updates and re-working rejected claims burns through valuable time and resources, costing an average of $10 to $25 per rejected professional claim to resolve (approximately).

The solution isn’t just about repricing; it’s about validating and perfecting the claim before it leaves your system. This is why a targeted Medicare repricing SaaS solution that incorporates robust, automated editing is non-negotiable for achieving a high first-pass rate.

Introducing the Power of Automated Editing

CMSPricer offers a powerful, dedicated editing-only feature that acts as a quality control checkpoint, ensuring your claims are clean and compliant from the start. This functionality is delivered via a fully automated API,which integrates directly witho your existing billing system for seamless operation. By leveraging this sophisticated SaaS Medicare repricing software, you gain an instant, competitive Medicare repricing system that prevents downstream denials and accelerates your cash flow.

What exactly does this automated editing engine validate? It covers the full spectrum of necessary compliance checks, including:

• Professional (CMS 1500) and Institutional (UB04) CMS rules.
• Diagnosis Code Validation, Age Edits, and Modifier Edits.
• Medical necessity checks via Local Coverage Determination (LCD) and National Coverage Determination (NCD).
• Compliance with industry standards like Outpatient Code Edits (IOCE), Medically Unlikely Edits (MUE), and the Correct Code Initiative (NCCI).

The Clear Benefits of Real-Time Validation

Implementing CMSPricer’s editing solution provides immediate and quantifiable benefits that transform your revenue cycle:

• Avoid Redundant Work: Eliminate the need to automate Medicare repricing and editing rework on erroneous claims.
• Increase Compliance: Drastically improve correct coding compliance and reduce days in Accounts Receivable (A/R).
• Identify Missed Revenue: Pinpoint and remedy medical necessity or coding issues before claim submission.
• Speed to Revenue: The system identifies rejections instantly, prior to sending to your EDI clearinghouse. This can save you an average of 24 days of waiting for rejection notices, allowing you to make corrections immediately.

The results are conclusive: our clients experience a significant reduction in denials, the identification of missed revenue opportunities, and a clean claim/first pass submission rate of greater than 98%.

Simplify Your Workflow and Stay Current

The best part? It’s incredibly simple to integrate and manage. Step 1: Simply configure which edits you want “on” or “off” within the system. For maximum efficiency, clients run an API feed that provides easy and automatic feedback right into your process workflows.

This continuous automation means you no longer have to worry about chasing down the daily changes to CMS rules, understanding new coding initiatives, or familiarizing yourself with every new regulation. The necessary edits and updates are automatically pushed and updated via API directly into your billing system, allowing you to focus on patient care and service delivery while the software ensures financial integrity.