Transfer your knowledge into custom-built rules to address your payer requirements, specialties, value-based contracts, and more. Ensure the cleanest claims go out—every time.
“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 them.”
A charge coming from the EMR into the RCM system consists solely of the professional component, but this medical group is able to bill for the technical component as well.
A custom rule to automatically add the technical component to a claim. The rule knows which charges require the technical component based on the location and CPT data.
Lab charges affiliated with an office visit are not sent to the RCM system until 24-48 hours after the office visit, but the medical group needs all CPTs included on a single claim.
A custom rule to “suspend” office visits for 24-48 hours. Then, every day, check for lab charges affiliated with an office visit and combine all CPTs onto a single claim.
An appointment is scheduled with the accurate location, but the provider chose a different (incorrect) location in the EMR during the visit.
A custom rule to compare the appointment data to the charge data and overwrite the incorrect data automatically.
Even though a vaccine is state supplied, the medical group must bill the CPT on a claim and include an SL modifier to denote the vaccine as a $0 charge.
Custom rules based on patient age, payer, and vaccine to automatically add the SL modifier when appropriate. Note: Any rule can be automated, so you can automate all administration code billing requirements.