In the 1990s, the Centers for Medicare & Medicaid Services introduced the National Correct Coding Initiative to promote accurate coding and minimize incorrect coding and fraud. It helped reduce delays, denials and inquiries that can bog down a practice’s accounts receivables. NCCI edits are now a nationally recognized and widely used standard for editing claims for accurate coding and reporting of services.

But several hundred new and revised codes are introduced every year, and thousands of new ICD-10 codes are just around the corner. And that’s adding pressure to coders, whose accuracy can make a difference in their practice’s reimbursement.

While certain manual efforts like training, documentation and periodic quality checks can support accuracy efforts, a professional claim scrubbing tool can automate claim reviews to scan for compliance with NCCI and other coding regulations and requirements – a review that, when performed manually, can be daunting for even the most experienced coders. MGMA’s bestseller The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid1 advises taking advantage of automated technology tools that build coding rules into your practice management system, check for errors and correct mistakes prior to claims submission to reduce denials.

Lost revenue due to coding and billing errors is estimated at $100 billion annually2.

We often hear from practices that investigating claim denials that correcting the claims and resubmitting is too labor-intensive and time-consuming, and so they don’t pursue denials on a regular basis. Don’t leave money on the table because you’re left chasing back-end denials – manage claim submission up front with the help of an automated claim scrubber that allows you to submit clean claims and recover payment in a timely fashion.

An analysis of Availity client trends over a five-year period revealed that claim denials were reduced up to 60 percent by using our claim scrubbing tool, advanced claims editing. Those same clients saw days in A/R go down 30 to 50 percent. Bottom line – accurate coding and clean claims directly correlate to reimbursement.

Don’t let denials tie up your cash flow.

1 Keegan, D.W. et al (2008). The Physician Billing Process: 12 Potholes in the Road to Getting Paid. In Pothole 6: The Claims Management Process (pp 119-138). Medical Group Management Association publications.

2 HHS Inc. (2009) America’s Hidden Healthcare Crisis.