“Now out of 3,000 tasks a day, we probably have to manually review about 100. Everything else automatically posts. Clean claims go out the first time without the need to review.”
Christi Garriot, Senior Vice President of Business Intelligence and Revenue
Peak Vista Community Health Centers
Trusted By
Customization and Control
You and your team are already experts at navigating the complex world of dermatology revenue cycle management. We’ll work with you to identify critical areas where custom rules can dramatically reduce the burden of manual effort by automatically correcting routine billing errors.
Custom Dermatology Rule Examples
The Challenge
When billing for separate or additional lesions, each additional biopsy should be listed separately, not as one line with units greater than one.
The Solution
This rule flags encounters containing biopsy codes with more than one unit for review so a coder can ensure each additional biopsy is reported with the add-on code that represents the technique used (tangenital, punch, incisional, etc.).
The Challenge
An excision of a benign lesion 0.5 cm or less is billed with an intermediate or complex closing.
The Solution
When billing the excision of a benign lesion of 0.5 cm or less using procedure codes 11400, 11420 or 11440, this rule flags the encounter so a coder can review documentation to confirm there was an intermediate or complex closing. If not, the coder can remove the closing code. If so, they can confirm the correct closing code and override the rule break.
The Challenge
Photodynamic therapy is billed without photosensitizing drugs.
The Solution
When billing for photodynamic therapy with procedure codes 96573 or 96574 there should also be J procedure codes for photosensitizing drugs (J7308, J7309, J7345, etc.). This rule identifies encounters that are missing those codes and directs them to a coder to add the corresponding J code with the correct number of units.
The Challenge
The diagnosis is side-specific (affecting the right or left side of the body) and needs a laterality modifier.
The Solution
When billing with a diagnosis code that specifies left side or right side, this rule automatically adds the appropriate LT or RT modifier.
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The Challenge
When billing for separate or additional lesions, each additional biopsy should be listed separately, not as one line with units greater than one.
The Solution
This rule flags encounters containing biopsy codes with more than one unit for review so a coder can ensure each additional biopsy is reported with the add-on code that represents the technique used (tangenital, punch, incisional, etc.).
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The Challenge
An excision of a benign lesion 0.5 cm or less is billed with an intermediate or complex closing.
The Solution
When billing the excision of a benign lesion of 0.5 cm or less using procedure codes 11400, 11420 or 11440, this rule flags the encounter so a coder can review documentation to confirm there was an intermediate or complex closing. If not, the coder can remove the closing code. If so, they can confirm the correct closing code and override the rule break.
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The Challenge
Photodynamic therapy is billed without photosensitizing drugs.
The Solution
When billing for photodynamic therapy with procedure codes 96573 or 96574 there should also be J procedure codes for photosensitizing drugs (J7308, J7309, J7345, etc.). This rule identifies encounters that are missing those codes and directs them to a coder to add the corresponding J code with the correct number of units.
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The Challenge
The diagnosis is side-specific (affecting the right or left side of the body) and needs a laterality modifier.
The Solution
When billing with a diagnosis code that specifies left side or right side, this rule automatically adds the appropriate LT or RT modifier.
Fix Bad Data Up Front
The prevalence of EMRs has led to a daily onslaught of bad electronic billing data. Since providers didn’t go to medical school to become coders, you end up with a lot of errors to sort through. And while you didn’t create this system, you are responsible for managing it. RCxRules is here to help–cleaning data at the beginning of the process, saving you countless hours of manual work.
Build a Knowledge Base
Multiple spreadsheets, sticky notes on someone’s desk—chances are your hard-earned institutional knowledge is scattered across your organization. RCxRules gives you one location to host your organization’s billing and coding knowledge. This centralized knowledge base allows you to keep up with ever-evolving payer requirements and make sure everyone on your team handles billing and coding issues exactly as instructed for every encounter—as if you were personally sitting next to each one of them as they work.
Optimize Staffing
Historically, the charge review process required extensive and expensive staffing. With RCxRules, that outdated approach is a thing of the past. RCxRules identifies only those charges that require manual review, so your team can focus their efforts where they’re needed most. Simply put: hire technology, not more people.
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Fix Bad Data Up Front
The prevalence of EMRs has led to a daily onslaught of bad electronic billing data. Since providers didn’t go to medical school to become coders, you end up with a lot of errors to sort through. And while you didn’t create this system, you are responsible for managing it. RCxRules is here to help–cleaning data at the beginning of the process, saving you countless hours of manual work.
-
Build a Knowledge Base
Multiple spreadsheets, sticky notes on someone’s desk—chances are your hard-earned institutional knowledge is scattered across your organization. RCxRules gives you one location to host your organization’s billing and coding knowledge. This centralized knowledge base allows you to keep up with ever-evolving payer requirements and make sure everyone on your team handles billing and coding issues exactly as instructed for every encounter—as if you were personally sitting next to each one of them as they work.
-
Optimize Staffing
Historically, the charge review process required extensive and expensive staffing. With RCxRules, that outdated approach is a thing of the past. RCxRules identifies only those charges that require manual review, so your team can focus their efforts where they’re needed most. Simply put: hire technology, not more people.
