Case Study: Accurate charge capture and customized coding edits in charge capture application has reduced denial rate by 12%
Client:
A large physician group who has an expansive physician network across the united states with high-quality hospitalists and surgicalists that are passionate about helping rural hospitals meet the needs of the communities they serve.
Challenge
Physicians are entering their charges i.e CPT and ICD-10 codes in a charge capture application based on the service provided for the date of service for each patient that they have treated. They faced 12% coding denial rate due to incorrect coding by the providers hence the provider group approached Annexmed to validate their charges which were entered in the charge capture applications before claim submission.
In earlier days of the process, we have noticed physician entered incorrect/incomplete ICD-10 codes, incorrect E/M code for the services provided, incorrect POS, and missed to append modifier for CPT codes since the providers are not well versed with coding knowledge.
Solutions
Annexmed has allocated experienced certified auditors who had experience in both outpatient and Inpatient E/M coding speciality. Our coding experts have analyzed the historical denials and rejection trends to get the top denial and rejection trends. We then created a process of communication system via charge capture application itself to educate the physician on their coding errors to avoid future denials. We also created a customized coding edits in the charge capture application to highlight any coding errors before claim submission. We also tracked the weekly physician charge capture error rate and top error trends based on our audits and then provided the dashboard on a weekly basis to the provider group.
Results
With the customized coding edits in the charge capture application system and continuous education to the physicians, the denial rate has got decreased from 12% to less than 1%. With our experts’ audits and regular feedback, the physician charge capture error rate has significantly come down which resulted in significant increase in cash flow.
Key Benefits
- Decreased coding denial rate
- Improved physician charge capture accuracy
- Increased cash flow