Revenue Cycle Uncovered

Inside the Claim Edit Library · Article 2 of 6 Before the Claim Takes Shape A charge doesn't always travel directly from an electronic health record into a practice-management system unchanged. In some environments, another layer of software examines the information during that journey, identifies discrepancies, and performs defined actions before the charge enters billing. This application of business-rule automation gives organizations an opportunity to address certain conditions while information is moving between applications, before the billing team encounters them in a completed claim. Recognizing a problem and changing the underlying data, however, require different capabilities. Where Inline Editing Fits Inline editing refers to checks performed within an active processing workflow, although the term encompasses different functions across software products. NextGen, for example, describes In-Line Edits within its PM billing environment. Its separately described C...

Inside the Claim Edit Library · Article 1 of 6 The Rules Behind the Claims A billing specialist opens a claim and finds three messages. One identifies missing subscriber information. Another flags a procedure combination for coding review. The third warns that the claim may not satisfy a requirement associated with its payer. All three appeared during the same review, but they may have originated from different rules, each with its own purpose and consequences. These messages are the visible results of a larger set of instructions governing how billing information is evaluated. Understanding a claim edit library begins with understanding the rules behind them. Behind an Edit Message A claim edit library brings together the rules an application or service uses to evaluate billing information. Some are supplied and maintained by the software vendor, while organizations can configure their own checks or obtain them through additional editing services. An individual edit typicall...