Claim Scrubbing

Medical coding is one of the most important challenges healthcare professionals face today. Errors in coding can mean lost revenue, audits, and legal penalties. In healthcare, coding equals money -- the average physician practice loses $50,000 a year due to incorrect coding.

With the implementation of the Correct Coding Initiative/Policy by the Centers for Medicare & Medicaid Services (CMS), errors in coding can have significant financial ramifications.

Scrutinize each encounter to ensure accuracy

Our code scrubbing software scrutinizes the coding per encounter on a real time or batch mode. This will help:

Identify applicable and mandatory modifiers for selected CPT codes

Check for medical necessity by justifying the ICD-9 code to the CPT code

Sequence ICD-9 codes based on acuity and severity

Make edits for ICD-9 codes that do not support a selected CPT code

Review of ICD 9 and CPT Codes

The code scrubbing software scrutinizes an encounter just like an insurance carrier does helping to:

Eliminate any potential delay in reimbursement caused by coding errors.

Ensure clean claims submission

Reflect a more accurate picture of the EHR record

Recommendations of modifiers

Our claim scrubbing software allows the EHS system to generate the E&M that providers need to escape the under-coding or over-coding dilemma. Without some form of E&M system, organizations tend to under-code to avoid the inherent dangers of over-coding. Through careful calculation of the ICD-9 and CPT code mixes, we are able to produce accurate E&M billing components.