Work claim edits remotely – a great idea for many hospitals.

We all want to handle claims only once. We do all we can to preclude denials. But when you categorize the reasons your scrubber rejects claims, you find that in order to resolve that prioritized list, many disciplines have to get involved e.g. coders, clinicians, charge master, and perhaps the patient. Often more than one of these disciplines is involved so that tracking resolution progress becomes a challenge. That said, most hospitals find that a credentialed coder can quickly resolve a high percentage of edits. Coders are in high demand and short supply so therein lays a challenge in many communities.

One hospital has addressed this challenge by using remote coders to manage claim edits. This is different than the commonly used practice of remote coding because the work volume includes only rejects, not initial charts and the work list is generated out of the billing system. All claims “kicked out” by the billing edit system for a coding-related reason are routed electronically to a remote coder who has access to facility records via VPN. Claims are resolved same day and returned for billing. The hospital has captured the following benefits as a result of this protocol:

 

    • Claims are turned around for billing immediately instead of enduring a routing process in the hospital. The hospital gets paid faster.

 

    • There is little or no allocation of hospital based coder time to respond to billing requests. Vacancy, vacations, volume swings and other factors driving the availability of hospital based coders to work on claim requests are no longer a problem for billing.

 

    • It is a cost effective way to access professional coding time. As volumes fluctuate from day to day, utilization of the remote coder time fluctuates proportionately.

 

  • Remote coders can focus on identification of patterns and recommend solutions easily because they are focused only on claims that have rejected. They might recommend charge master updates, new coding practices, physician education and/or many other ideas.

 

The process is very easy to implement and there is no start-up cost. If you are already using remote coders to work your edits, please share your experience with us. If you are considering it, please feel free to contact Nearterm and we will be happy to explore the details with you.

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Posted By: Nearterm Houston