Senior Vice President of Business Intelligence and Revenue, Peak Vista Community Health Centers
Director of ACO Operations, Arizona Community Physicians
Customization and Control
You and your team are already experts at navigating the complex world of revenue cycle management. We’ll work with you to identify critical areas where custom rules can dramatically reduce the burden of manual effort by automatically correcting routine billing errors.
Custom Rule Examples
The Challenge
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.
The Solution
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 and CPT data.
The Challenge
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 CPTs included on a single claim.
The Solution
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 CPTs onto a single claim.
The Challenge
An appointment is scheduled with the accurate location, but the provider chose a different (incorrect) location in the EMR during the visit.
The Solution
A custom rule to compare the appointment data vs the charge data and overwrite the incorrect data automatically.
The Challenge
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.
The Solution
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.
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The Challenge
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.
The Solution
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 and CPT data.
-
The Challenge
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 CPTs included on a single claim.
The Solution
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 CPTs onto a single claim.
-
The Challenge
An appointment is scheduled with the accurate location, but the provider chose a different (incorrect) location in the EMR during the visit.
The Solution
A custom rule to compare the appointment data vs the charge data and overwrite the incorrect data automatically.
-
The Challenge
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.
The Solution
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.