Claim Expert Reduces Denials By 90%
MDeverywhere’s Palm and web-based charge capture software includes a rules engine with 15 million pre-defined payor-specific rules. These rules identify errors in recorded charges at the point-of-care to ensure accuracy and HIPAA compliance. These payor-specific rules fall into the following general categories:
Payor Specific Rules Include:
- Missing or invalid CPT Code
- Invalid modifier w/CPT
- Invalid modifier w/ other modifier
- Modifier -25/26 required
- Rebundle to appropriate procedure code
- Unbundled Procedure
- Unbundled E/M services
- Established vs. New patient
- Patient age not valid for procedure
- Global editing 30, 60, 90 all payers
- Conflicting E&M / Procedure
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- PT Gender missing or incorrect
- ICD code invalid or missing
- LCD Local Carrier Policies
- Diagnostic test in hospital setting
- Post-op unrelated service
- Place of service not typical
- Missing or invalid place of service
- Medicare Unrelated surgery
- Referring Physician
- Referral Authorization Number
- Missing Demographic Information
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In addition to these pre-defined rules, MDeverywhere builds new client-specific rules based on the client’s denial trends and payor mix so the system gets smarter over time. MDeverywhere practices experience an increase in revenue due to a 90% reduction in denials.
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