Introduction
In today’s healthcare landscape, there are many ways for a claim to be denied. While pre-bill review helps identify and address these denials as quickly as possible, it can also help uncover other areas where underpayments are occurring. Pre-bill review is conducted by a team of revenue integrity professionals who analyze submitted claims for errors including coding errors (incorrect diagnosis codes or procedure codes), charge capture errors (such as missing information required for payment such as supplier IDs), and revenue code edits (changes made by payers).
Pre-bill review is typically done after the claim has been submitted but before it is processed by the payer. This gives you time to respond to any issues raised by the payer before they process your claim.
A common misconception about the pre-bill review is that it only looks at denials from health plans – not all denials are from health plans! Denials can come from other payers such as Medicare or Medicaid. These denials may be due to:
Coding errors – If the diagnosis code on your claim doesn’t match what a health plan expects based on their coding rules, they may deny your claim. Coding errors can happen when you fail to update a patient’s condition or if you under or over code.
In today’s healthcare landscape, there are many ways for a claim to be denied. While pre-bill review helps identify and address these denials as quickly as possible, it can also help uncover other areas where underpayments are occurring.
At WWS Pre-bill review is performed by a team of revenue integrity professionals who analyze submitted claims for errors including coding errors (incorrect diagnosis codes or procedure codes), charge capture errors (such as missing information required for payment such as supplier IDs), and revenue code edits (changes made by payers).
This allows your practice to stay on top of denied claims and prevents delays in payment from occurring.
A pre-bill review process can be initiated by tracking denials as they move through the revenue cycle—from initial submission to claim denial and rework. However, this comes with an inherent challenge: obtaining and analyzing data from multiple sources. Section: The most effective way of gathering data is through a comprehensive business intelligence platform that will allow you to pull data from multiple systems and sources that you currently use and discover trends across your enterprise and sources that you currently use, discover trends across your enterprise, identify opportunities for improvements, and make recommendations based on these insights.
A few examples of business intelligence platforms include:
● Microsoft Power BI
● Xpropeller
● QlikView
Conclusion
The pre-bill review process helps your team uncover errors in claims before they are submitted to the payer, which can save time and money in the long run. This process involves analyzing denials that have already been sent back by the payer, but there are some key considerations when implementing a pre-bill review program.
An Automation Driven Revenue Cycle Management Solutions – https://www.wonderws.com/
