Ensuring accuracy in coding and billing processes traditionally involves a significant amount of manual review work. At RCxRules, our focus is on automating as much of this manual work as possible, so revenue cycle teams can optimize their time and direct their expertise where it’s most needed.
So how do revenue cycle management teams use our automation in the real world? We recently attended the NextGen user conference, where we heard from some of the 70+ NextGen groups using our Revenue Cycle Engine. Below are some of the manual processes these groups have automated using our solution.
Ensuring accurate payment for immunizations is a daunting task. The Revenue Cycle Engine makes it much easier, with over 50 rules that address immunization requirements, over 95% of which are automated. For example, the flu vaccine for Medicare requires an associated G0008 code, which is automatically added by a rule if missing.
If the provider and location on a given encounter do not match, the Revenue Cycle Engine can automatically correct the issue or flag the encounter for review. If the location scheduled doesn’t match the location entered in the EHR, a rule will automatically default to the scheduled location. If the provider scheduled doesn’t match the provider entered in the EHR, a rule will flag the issue for review.
Telehealth & COVID Requirements
The Revenue Cycle Engine offers a set of top telehealth rules that help ensure complete and accurate payment for telehealth visits. For example, if the payer requires a modifier for telehealth services, there is a rule that reviews the payer and service and automatically assigns the appropriate modifier. Many customers use Appointment Type to define E&M services for both video and phone visits.
Searching for clinical values in the EHR and determining the applicable CPTII or diagnosis code is a manual, time-consuming and error-prone process. It involves noting the presence of clinical values such as BP, HbA1c, and others, determining the value’s threshold, and researching the appropriate CPT II code or diagnosis code to add.
With the Revenue Cycle Engine, clinical data is extracted from the NextGen EHR and stored in RCxRules. As charges come into RCxRules, the “Clinical Metric” rules ask if there is there a clinical value associated with the charge. If yes, the rules determine if a diagnosis or CPTII code is applicable and automatically add the code(s). If no, the rules can hold the charge (i.e., for 24 hours) and check again before releasing the charge to the NextGen PM.
Consult Codes & Cross Walks
Do clinicians know which payers recognize consults? Most groups suggest their providers select and document consults (when the service is a consult) regardless of the payer. Processes are set up so consult codes can be manually reviewed and cross walked to the appropriate code, depending on the payer.
By accounting for payer, new vs. established patient, and time spent with the patient, the RCxRules Revenue Cycle Engine can automatically create the most appropriate code(s).
Learn more about how you can automate these same manual processes and more with the RCxRules Revenue Cycle Engine. Set up a 1:1 meeting today.