Featured Case Study
customer success
Pathology billing team finds $331M in billing errors.
A pathology-focused billing company reviews $1.9B in billed claims, uncovers recurring CCI conflicts, and refines clinical and anatomical pathology logic to protect reimbursement without weakening valid edits.
RESULTS
Proof in practice.
- $1.9B total billed claims
- $331M total billed errors identified
- 17.34% total services billed with errors
A billing partner with deep hospital-based physician expertise.
A large medical billing company specializing in outsourced billing for hospital-based physicians wanted to maximize profitability for their clients. Staff had extensive experience in certain specialties, such as pathology, and used that knowledge to implement comprehensive physician billing services.
Searching for guidance.
As regular users of ClaimStaker, the organization was seeing a large number of edits related to the National Correct Coding Initiative (CCI) when billing for their pathology clients. When claims containing clinical and anatomical pathology codes were downloaded from the hospital system and run through ClaimStaker, CCI edits repeatedly triggered because even some payers like Medicare will not reimburse these code types on a professional claim. Not wanting to turn off such valuable edit, the billing service contacted Aptarro.
With the help of the billing service’s pathology experts, our team researched and expanded our offering of CCI edits, better accommodating the specialized billing needs of their pathology clients. Instead of a general CCI code combination edit, additional edits specific to clinical and anatomical pathology were made. And with the custom configurations available within ClaimStaker, these newly developed edits moved into production for all users.
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