Featured Case Study
customer success
Pathology experts expand edits and reduce denials
A large medical billing company specializing in outsourced billing for hospital-based physicians wanted to ensure they were maximizing profitability for their clients. The staff had extensive experience in certain
specialties, such as pathology, and used that knowledge to implement comprehensive physician billing services.
RESULTS
Proof in practice.
- $1.9B total billed claims
- $331M total billed errors* identified
- 17.34% total services billed with errors
Searching for guidance
As regular users of ’s Aptarro’s claim editing solution, ClaimStaker , the practice 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 for guidance.
At Aptarro, we pride ourselves on our personalized customer service. With the help of the billing service’s pathology experts, we were able to research and expand our offering of CCI edits to better accommodate the specialized billing needs of their pathology clients. Instead of a general CCI code combination edit, we developed additional edits specific to clinical and anatomical pathology. And with the custom configurations available within ClaimStaker, these newly developed edits were available to all Aptarro users.
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