Claim Edits and Remediation
We examine the entire claim encounter and all related charges to address overreaching issues and stop repetitive costs.
Claim Edits and Remediation Solutions
Developing clean claims with complete and accurate information is an essential step in reducing payer denials, avoiding A/R delays, and ensuring your revenue cycle performs properly. AQuity claims editing solutions resolve these issues, reducing pre-bill edit queues and creating thorough, detailed bills that are accepted by payers the first time they are submitted.
Best Practices
When it comes to medical claim edit and remediation services, AQuity ensures accuracy, efficiency, and compliance through proven processes:
Experienced Staff
The AQuity Revenue Integrity team consists of 100% credentialed, skilled professionals with expertise in medical coding, billing, and claim processing. Our industry leading reputation comes from their knowledge of relevant coding guidelines, payer policies, and regulatory requirements.
Keeping up with Industry Changes
Reimbursement policies and regulatory changes for medical coding and billing practices are constantly changing. To ensure we support the most current rules, the AQuity team is trained and tested monthly on how those changes impact their role and the services we provide.
Robust Quality Control
AQuity Revenue Integrity services include an exceptional quality assurance program designed to validate claims for accuracy and compliance. These efforts include regular audits of coding and billing policies, procedures, and practices to ensure issues are identified resolved early.
Leverage Technology When Appropriate
To achieve optimal results, the balance between labor and technology contributions is ever changing. AQuity utilizes advanced software automation tools, support by human editing and validation oversight, to optimize our claim editing and remediation services.
Adherence to Coding Guidelines
Strict compliance with International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) guidelines ensures accurate and specific coding compliance based on proper clinical documentation support for the medical necessity of services rendered.
Monitor and Address Denials
All claim denials are closely monitored to identify patterns and trends. Thorough analysis of the reasons behind these denials help to identify the root causes and are used to develop strategies for appropriate corrective measures and prevent future occurrences.
Training and Education
AQuity provides ongoing training sessions to help keep our staff current with the latest industry updates as well as enhance their knowledge and skills. This includes keeping them informed of rule changes, payer policies, documentation requirements, and evolving compliance regulations.
Effective Communications
Clients consider the consistency and clarity of our communications as one of our greatest strengths. AQuity communication regularly with all Revenue Integrity team members within our provider clients as well as with payers to clarify expectations and resolve disputes efficiently.
Security and Privacy
AQuity maintains SOC 2 Type 2, ISO 27001, ISO 9001, KLAS Censinet, and other security and privacy certifications to ensure proper handling of patient health information PHI in compliance with HIPAA and other internationally recognized security and privacy guidelines.
Continuous Process Improvement
The AQuity Claim Edits and Remediation approach leverages a formalized continuous process improvement discipline to identify opportunities to increase the value we offer our clients. This approach includes analysis of key performance indicators KPI for workflow efficiency and results accuracy.
Speak with an AQuity Audits and Records Analyst
AQuity is a nationally recognized leader in Coding Audits and Records Analysis. Contact us today to discuss your objectives and learn how we can help.
Key Differentiators
The AQuity Revenue Integrity team covers the complete scope of Inpatient/Outpatient claim edits and remediations to identify and resolve specific denial issues and complete workflow efficiency and quality concerns.
- AQuity provides consultative claim edit and remediation services that definitively determine why edits are made, what causes the issue, what additional team member education or workflow adjustment is required for resolution.
- Our Revenue Integrity team works with several different departments outside of the HIM and coding groups as needed to address core upstream documentation or issues or downstream billing issues to drive improvements from a holistic approach.
- We recognize each client is different and assess workflow solutions that achieve a complete claim edit remediation solution.
- Unlike simple production claim editing workflows, our approach looks at the complete encounter and all potential justifiable charges, including supplies, devices, labs, and any other detail that could identify missed or under coded cases. Production team coders have specific specialties and typically do not have the broader-based knowledge to investigate other complexities the way our team does. Their edits are solely related to their specialty code set.
- We take a proactive approach that includes coding, documentation, and managed care departments to identify and conquer overarching issues versus single claim remediations.
Areas of Claim Edits and Remediation
Total Quality Audits
Examine, identify problematic areas related to coding, documentation, quality;
Targeted Reviews
New physician or targeted physician quality review, physician practice merger/acquisition, System Integration.
Pre-Bill Audits
Pre-bill function, inclusive examination including MSDRG, Hospital Acquired Condition (HAC Indicators), Discharge disposition and Charge capture assessment, performed prior to claims submission.
System Integration Advisory
Consultative services for Go-to-live EPIC implementations.
Speak with an AQuity Audits and Records Analyst
AQuity is a nationally recognized leader in Coding Audits and Records Analysis. Contact us today to discuss your objectives and learn how we can help.
