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Customization and Control
You and your team are already experts at navigating the complex world of orthopedic 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
The GP modifier for outpatient physical therapy is missing.
The Solution
When billing Medicare for physical therapy services rendered under a physical therapy plan of care, a GP modifier is required. This rule automatically adds the necessary modifier.
The Challenge
The diagnosis code for aftercare following joint replacement surgery also needs a diagnosis code identifying the joint.
The Solution
When billing 99024 with a primary diagnosis of aftercare following joint replacement surgery (Z47.1), a diagnosis code is needed to identify the joint (Z96.6). This rule flags the encounter for review so a coder can determine the appropriate code and update the encounter.
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.
The Challenge
The CQ modifier for outpatient physical therapy services by a physical therapist assistant is missing.
The Solution
When billing Medicare for physical therapy services rendered by a physical therapy assistant (PTA), a CQ modifier is required. This rule automatically adds the necessary modifier.
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The Challenge
The GP modifier for outpatient physical therapy is missing.
The Solution
When billing Medicare for physical therapy services rendered under a physical therapy plan of care, a GP modifier is required. This rule automatically adds the necessary modifier.
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The Challenge
The diagnosis code for aftercare following joint replacement surgery also needs a diagnosis code identifying the joint.
The Solution
When billing 99024 with a primary diagnosis of aftercare following joint replacement surgery (Z47.1), a diagnosis code is needed to identify the joint (Z96.6). This rule flags the encounter for review so a coder can determine the appropriate code and update the encounter.
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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.
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The Challenge
The CQ modifier for outpatient physical therapy services by a physical therapist assistant is missing.
The Solution
When billing Medicare for physical therapy services rendered by a physical therapy assistant (PTA), a CQ modifier is required. This rule automatically adds the necessary 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.
