How You Can Avoid Rebilling Errors in Medicare Claims?

Are you looking for a Medicare repricing tool that can eliminate your rebilling errors in Medicare claims? Looking for such a tool to provide claim line level detail and summaries of Medicare claims repriced to Medicare rates, easily, quickly, and flawlessly? 

The Medicare Administrative Contractors (MACs) complain that they often see Medicare claim reports replete with errors. As examples of a few error-full Medicare claims that crop up on those claim reports are as follows:

  • Duplicate reports 
  • Invalid or inconsistent place of service code
  • The primary identifier of the referring physician is missing or incorrect

Payment or processing of the claim was not possible due to missing information, according to the MAC message. ‌ There exist insufficient or inaccurate details in the claim, and you do not have an appeal right ‌ since ‌ ‌ it ‌ ‌ ‌cannot‌ ‌be‌ ‌processed. ‌Therefore, you’re requested to resubmit this claim with accurate details. This is a real hassle for them when done manually, especially, or with a tool that is not that much competent.

What are the Reasons for These Errors?

The payers tend to encounter these errors due to code complexity, the CMS rules changing almost every day, and regulatory changes.  ‌As a result of code compatibility issues, CMS rules, diagnosis code validation issues, and so forth, ‌MACs send messages to payers and their organizations asking for the correction of the errors, and, if such incidents occur frequently, the end-users suffer a delay in receiving their care.

CMSPricer – The SaaS-based Medicare Repricing Tool

The role of a cloud-based Medicare repricing tool like CMSPricer is valuable, saving both time and cost for users. It offers an automated feature for claims validation in advance of their generation and submission to payers. That means there would hardly be any chance of downstream denials and consequent delayed payment. 

CMSPricer features a fully automated editing solution via API that streamlines processes. 

How‌ ‌Does the CMSPricer System Handle These Edits?

Users just need to sign in to their individual system dashboard. While logged in, they’ll see the items they can edit 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

As a user, you will be able to easily identify missed revenue opportunities, clean claims, first past submission rate of >98% and so forth. 

How Can CMSPricer Help Payers Edit Medicare Claims?

CMSPricer offers many advantages when it comes to producing error-free Medicare claims, as was already mentioned. ‌When working the revenue cycle, CMS Pricing is designed to help increase first pass-through rates for claims.

In addition to eliminating the redundant work of rebilling erroneous claims, you will also reduce accounts receivable days, identify and resolve medical necessity issues before claim submission, increase correct coding compliance, and receive real-time error information.

Key Takeaways

In addition to reducing payment denials, speed to revenue and AR days, you’ll save 24 days of waiting for rejections and making corrections by detecting rejections before they reach your EDI clearinghouse. ‌You will also save money with the CMSPricer Medicare Claims Editing Module, as the average cost of re-working a rejected claim is‌ ‌between‌ ‌$10‌ ‌and‌ ‌$25. Edits are automatically reflected in your billing system: You don’t have to stay on top of CMS changes or learn coding initiatives. ‌APIs automatically push the latest updates.

Want to experience the ease of repricing Medicare claims? Let’s get started with CMSPricer.