How a SaaS Repricing & Editing Tool Can Minimize Redundancy & Denials in Medicare Billing?
Medicare claims are often difficult for payers to process error-free. They frequently receive reports of claim errors from Medicare Administrative Contractors (MACs).
Payers Often Commit The Following Types Of Errors.
- Several claims have been duplicated.
- An incorrect or missing physician identifier.
- There is an error or inconsistency with the POS code.
It may appear in MAC messages that MAC cannot process a claim without missing information in their message. Your claim cannot be processed because of incomplete or inaccurate information, and you do not have the right to appeal. Providing the correct information in a new claim would be helpful.
A Medicare claim is usually void/canceled if it was submitted in error. Voids/cancels must include TOB XX8 and DCN, along with condition codes D5 (an incorrect Medicare ID number or National Provider Identifier (NPI) entry) or D6 (an incorrect duplicate payment entry). Indicate in the remarks why the claim is being void/canceled.
How Do Medicare Claim Processing Errors Happen?
CMS rules change almost daily, and code complexity complicates Medicare claims’ rate processing for payers. In the event of any compatibility issues with codes, CMS rules, diagnosis code validation, and so on, the MACs will send messages to payers and their organizations asking for corrections, and if this occurs continuously, end-users will not be able to achieve their goals. Manually editing Medicare claims can easily lead to data errors.
How A Saas Medicare Repricing And Editing Tool Can Help You In Medicare Billing?
- Identifying and correcting errors in Medicare claims before they are submitted to payers can be made possible by automating the process of repricing and editing claims.
- Providing payers with real-time feedback on claims can allow them to identify and correct errors more efficiently.
- Identifying trends and areas for improvement by generating reports on claim denials and redundancy.
What Can CMSPricer, A Saas Medicare Repricing Tool, Do To Speed Up The Process?
With CMSPricer, users can reprice and edit Medicare claims before submitting them to payers using a SaaS-based, easy-to-use software solution. API-enabled CMSPricer editing prevents downstream denials and delays, thereby avoiding late payments and denials.
If you don’t get the right Medicare claims repricing and editing entries with CMSPricer, you can recheck and generate submission reports until you do.
How Do CMSPricer Edits Work?
Signing into CMSPricer will show you what edits might involve. Here are a few of them:
- Diagnosis Code Validation
- Professional (CMS 1500) and Institutional (UB04) CMS rules
- National Coverage Determination (NCD)
- Correct Code Initiative (NCCI)
- Medically Unlikely Edits (MUE)
- Modifier Edits
- Advance Beneficiary Notice of Non-Coverage (ABN)
- CPT and RVU Edits
- Local Coverage Determination (LCD)
- Outpatient Code Edits (IOCE)
- Age Edits
With the editing system, you will be able to identify missed revenue opportunities, and more than 98 percent of claims will be clean or first time submissions.
What are the Benefits of CMSPricer’s Medicare Claims Editing Solution?
Medicare claims can be produced error-free with CMSPricer. By increasing the first pass through rate for claims, CMS Pricer helps increase revenue.
Aside from reducing receivables days, you can also identify and resolve medical necessity issues prior to claim submission, improve correct coding compliance, and receive real-time information about errors.
Final Thoughts:
You can save an average of 24 days awaiting rejections and correcting them by detecting rejections before they reach the EDI clearinghouse.
In addition to reducing costs, CMSPrice Medicare Claims Editing Module also allows you to rework rejected professional claims for a cost of around $10 to $25. As soon as the edits have been made, your billing system will automatically update. There is no need to keep track of CMS updates, learn coding initiatives, etc. Updates are automatically pushed by APIs. Does that sound interesting? Get in touch with us today to discover the difference!
Overall, a SaaS Repricing & Editing Tool can help payers to improve the accuracy and efficiency of their Medicare billing process, which can lead to reduced denials and improved cash flow.