Best Practices for Identifying Claim Errors Prepayment

As healthcare costs continue to soar& | Healthcare costs continue to soar and profits continue to stagnate. Faulty claims processing is partly to blame. Learn the best practices for prepayment claims editing.

As healthcare costs continue to soar and profits continue to stagnate, some of the blame can certainly be attributed to faulty claims processing. In fact, ineffective claims editing can lead to a cascade of expensive problems (e.g., high error rates, inaccurate and inconsistent assessment of claims, penalties for regulatory noncompliance, unnecessary overhead, and fraud and litigation costs). 

The numbers are staggering. 

• 80% of all claims containing coding or other errors
• 86% of denials are potentially avoidable and 34% are absolutely avoidable
• Almost 65% of claim denials are never resubmitted

Moreover, the ability to attract and retain participating providers depends largely on the payer’s ability to process and settle claims quickly and accurately. 

Chasing claims revenue is labor-intensive, laborious, and costly. That’s why finding a solution that maintains payer rules while allowing for custom rule creation is a necessity when evaluating clinical coding and editing software.  

Best Practices for Claims Editing

Once you’ve selected the right clinical coding and editing software for your organization, it’s time to start implementing. And since the best approach to identifying billing errors is to spot them prior to payment, here are a few tips and tricks to start you off on the right foot.