Pathology experts expand edits and reduce denials

Picture this… you’re a large medical billing company specializing in outsourced billing for hospital-based physicians. Your staff are experts in certain specialties, like pathology, but you’re struggling with edits triggered by the National Correct Coding Initiative (CCI). Claims with clinical and anatomical pathology codes keep getting denied because some payers—even Medicare—won’t reimburse them on professional claims. Turning off the edits isn’t an option, but leaving them on means claim delays, confusion, and potential lost revenue.

The results

Reduced/Reallocated

10+ FTEs

Reduced Time

from date of service to claim submission by two days

Decreased

clearinghouse and payer rejections by 3%

Improved

claim resolution rate by 25%

Proof

Real, satisfied customers

“I love the reports. They are a key tool in our monthly board meetings and revenue cycle board meetings, helping me demonstrate the ROI of RevCycle Engine. They provide a clear picture of how much work is being fixed before it ever becomes a problem, which is invaluable for keeping leadership informed.”

Director of Revenue Cycle

The providers are engaged in creating rules themselves. They’re asking, ‘Can this scenario be built into RevCycle Engine?’ They’re starting to think of clever ways to make the system work for them, even in smaller pain points. The physicians are most thrilled about how much less work they must do, such as ordering of codes. Engagement continues with new rules being added weekly.”

Director of Revenue Cycle

The group was able to reduce two full-time positions and reallocate another two full-time positions on their Charge Entry Team. They reduced 11 hours per day of manual charge entry; and automated charge cloning, missing charge reconciliation, and practice transfer. On their AR Team, they were able to reduce four and a half full-time positions and reduce denial tasks by 22%. Finally, on their Coding Team, they were able to reduce two fulltime positions and reduce coding denial tasks by 75%. In all, they were able to reduce or reallocate over ten full-time positions.

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In addition to remedying their staffing challenges, these changes positively increased staff morale and allowed for more professional growth among their existing staff. The simplified processes also eased staffing changeovers and reduced the administrative burden on IT.

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The time from date of service to claim submission was reduced by two days. Their clearinghouse and payer rejections decreased by 3%, backend rejections went from 40% of total rejections down to 15%, and their claim resolution rate three months after implementation was up by 25% of the available opportunity.

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