We work closely with you to create custom rules to meet your organization's unique needs and to ensure coding compliance. We then help you determine which rules can be set up to automatically correct routine billing errors, freeing up your team’s valuable time to focus on more important issues.
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/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 CPT’s 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 CPT’s 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 vs 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.
Working on the front-end of your process, RCxRules reviews all charges for coding completeness and accuracy right after entry into your EMR, before a claim is created.Learn More