It simply makes sense that claims that have been tested for accuracy against the payer's rules (or as much like the payer's rules as possible) will be processed more quickly and there will be fewer denials. That's the premise of claim scrubbing, and if your practice isn't taking advantage of it, you should be.
Your practice management and billing system should be integrated with a claim scrubbing program like Alpha II's Code Wizard. A claim scrubbed with Code Wizard is entered for payment, then processed against Alpha II's criteria. Potential problems and reasons for denial are flagged, which gives your clerk a chance to fix the claim before it ever goes to the payer—because fixing then is fast and easy. Filing a revised claim is more work and your payment will be delayed.
The Code Wizard:
- Identifies the applicable and mandatory modifiers for select CPT codes
- Checks for medical necessity by justifying the ICD9 code to the CPT code
- Sequences ICD-9 codes based on severity and acuity
- Makes edits for ICD-9 codes that do not support a selected CPT code
Because of these checks and edits, your denial rate will fall and time to payment will decrease.
You can get this functionality by selecting the right vendor for your practice management, billing and EHR system. Try comparing their functionality with these requirements.