Billing & Claims Editing Assessment

Our billing and claims editing assessment services are designed to evaluate existing technology to identify opportunities to enhance the logic, functionality, and workflow to support a compliant and efficient billing process. Our approach will identify the current state of functionality within the patient accounting system and claim editors, review of payer edits, claim acceptance rates, and evaluate staff proficiency in the claim editing process. We also review the claim submission and reconciliation process to ensure balancing processes are in place to prevent lost claims and timely filing denials. The assessment will identify issues with system configuration, claim editing, and claim reconciliation process impacting staff productivity and timely cash collections.

Our Assessment

We will identify the following:

• Claim generation volume and frequency
• Percentage of clean claims by payer and bill type
• Top error reasons by payer and bill type
• System functionality optimization targets
• Recommendations for claim reconciliation, balancing, and denial process