Reduce Denials & Redundancy in Medicare Billing with a SaaS Repricing & Editing Tool!

Payers often struggle to ensure zero-error in putting across Medicare claims. However, it is very common to them to receive reports of claim errors from the Medicare Administrative Contractors (MACs).

Below are a few common types of errors committed by payers.

  • Duplicate claims are present.
  • Missing or incorrect physician identifier.
  • Place of service (POS) code is invalid or inconsistent.

In the message from MAC, it may appear that payment or processing of the claim is not possible without missing information. Due to incomplete or inaccurate information, this claim cannot be processed, and you are not entitled to appeal. It would be helpful if you could submit a new claim containing the correct information.

In most cases, Medicare claims are void/canceled if they should not have been submitted in the first place. The TOB XX8 and DCN of the original claim have to be included in the void/cancel claim, as well as the condition code D5 (the Medicare ID number or National Provider Identifier (NPI) has been entered incorrectly) or D6 (the duplicate payment has been entered incorrectly). Specify the reason for voiding/canceling the claim in the remarks.

Why Do These Errors in Medicare Claim Processing Happen?

There are numerous changes in CMS rules almost every single day, as well as code complexity, which complicates Medicare claims’ rate processing for the payers. Payers and their organizations will receive messages from MACs asking for the correction of errors if there are any compatibility issues with codes, CMS rules, diagnosis code validation, and so on, and if this occurs continuously, the end-users will not be able to achieve their desired outcomes. Payments can easily avoid data errors caused by manual editing of Medicare claims.

Using CMSPricer, Payers Can Reduce Denials & Redundancy in Billing.

An automated Medicare claims validation solution, CMSPricer offers its users a SaaS-based, easy-to-use software solution for repricing and editing Medicare claims before submitting them to payers. CMSPricer’s API-enabled editing solution avoids downstream denials and delays, thereby avoiding downstream denials and late payments.

Using CMSPricer, you can recheck and generate submission reports until you get the right Medicare claims repricing and editing entries.

CMSPricer Edits: How Do They Work?

You can see what the edits could involve by signing into CMSPricer. They are as follows:

  • Diagnosis Code Validation
  • Professional (CMS 1500) and Institutional (UB04) CMS rules
  • National Coverage Determination (NCD)
  • Local Coverage Determination (LCD)
  • Outpatient Code Edits (IOCE)
  • Age Edits
  • Correct Code Initiative (NCCI)
  • Medically Unlikely Edits (MUE)
  • Modifier Edits
  • Advance Beneficiary Notice of Non-Coverage (ABN)
  • CPT and RVU Edits

Among the benefits of the editing system are the ability to identify missed revenue opportunities, as well as a clean claim/first past submission rate of more than 98%.

CMSPricer’s Medicare Claims Editing Solution: Why Should Payers Use It?

With CMSPricer, you can produce error-free Medicare claims for a variety of reasons. When working the revenue cycle, CMS Pricer helps increase the first pass through rate for claims.

You will also be able to reduce accounts receivable days, reduce redundant work of rebilling erroneous claims, identify and resolve medical necessity issues prior to claim submission, improve correct coding compliance, and receive real-time information about errors identified.

As a final note:

Detecting rejections before they reach the EDI clearinghouse will reduce payment denials, speed to revenue, and AR days, saving you an average of 24 days awaiting rejections and correcting them.

Using CMSPrice Medicare Claims Editing Module, you will also be able to reduce costs: reworking a rejected professional claim typically costs between $10 and $25. You will receive an automatic update to your billing system once the edits have been made. There is no need to track CMS changes, learn coding initiatives, etc. APIs automatically push updates. Sounds interesting? Contact us Today to experience the difference!