It’s now a proven fact. You can’t get the clean claims submission levels you need without adding automated claims editing to your claims processing workflow. Field data shows that clients reduce first pass claim denials by up to 15 percent after adding an automated claim review/claim edits solution to their practice management software platform.

It’s going to cost time and money without it.

Saying “no” to an automated claim review/claim edits solution… is expensive!

MGMA estimates the current re-work cost per “dirty claim” is $25. Preventing denials is critical because they represent 90 percent of missed revenue opportunities. On top of that, MGMA says that practices never work on 50-65% of denied claims, citing lack of time or knowledge. That’s significant potential for serious cash loss.

 “Change the way you look at things…and the things you look at change.”  That’s good advice, from renowned author Dr. Wayne Dyer, especially for automating your claims review process. Because, when you automate your process, everyone in the office must get used to new or adjusted workflows. It’s a necessary part of increasing revenue by using a claims automation solution across the practice.

The effort is well worth it, you’ll:

  • Reduce denials significantly by editing billing before the claim is created
  • Stay compliant with CMS and commercial payer guidelines; increase claim validity
  • Access, and automatic updates to, the most current and applicable payer rules
  • Improve practice efficiency and save your practice money by lowering the amount of time to rework and resubmit claims
  • Improve your practice’s overall revenue cycle; reduce days of outstanding A/R; optimize reimbursement
  • Improve staff productivity; eliminate staff time used to look up new payer rules that change continually

From denial management to denial avoidance… a different approach with better results. Here’s how we automate the claims processing workflow for our clients:

  • NextGen® Real Time Edits (NextGen® RTE), integrated into NextGen® Practice Management, is designed to let users review insurance rejections proactively; edit and audit patient encounter data before the claim is created.
  • Our solution looks for and confirms the accuracy of patient encounter data during the claim building process, on the front end of the claims process. Mistakes and/or inaccuracies are more easily identified and reviewed.
  • This all happens automatically in the cloud with no user maintenance or software updates, as users build claims prior to final review and submission to a clearinghouse or directly to a payer.

Incorporating an automated claim review/claim edits solution into your practice has moved from “nice to have” to “need to have” because catching claim problems before they happen is simply a better way. Not after submission, when dirty claims take twice as much time and effort to correct.

What is NextGen RTE?

NextGen RTE is an add-on claim edits automation program option that can be purchased to further edit claims prior to sending them to a payer or clearinghouse. The solution launches behind the scenes during the normal editing process by generating a request containing data for each claim. The request is submitted to the NextGen Real Time Edits Engine through an active secure Internet connection. The edits engine processes the request and generates a response which is integrated and fed back into the normal NextGen Practice Management edits process. The results display on the Claim Production Status report allowing hyperlinks to fix data prior to creating and sending the claim file.

Automated editing makes cleaner claims.  Imagine the time and money saved when one of your billing staff members is alerted instantaneously if they’ve begun creating a duplicate claim or is submitting a claim that lacks required information. Or in being alerted that the claim isn’t covered by the insurer. Or even if the time limit on a claim has expired. That’s the worst, because the revenue is lost for good, which happens to half of all denied claims, as I mentioned earlier. (Ugh. The worst!)

If you’re a NextGen RTE user, you automatically have your encounter data reviewed against one of the most expansive data sets in the nation that includes CMS rules: MCCI, LCD/NCD, Medically Unlikely and OCD rules; plus the NextGen RTE catalog of multiple adjudication rules across payers, NextGen® global rules, and the ability to request adjudication rules for any payer.

Look for a flexible, integrated automated claims editing solution.  When you evaluate an automated claims editing solution, make sure you’re looking at a flexible solution. One that can adapt with the changes and needs of your specific practice workflows. Your health information technology (HIT) vendor or consultant should offer this option as fully-integrated functionality into your existing practice management system. Not in a standalone silo where you rework claims “separately.” That would add time and cost where it’s not needed.

To learn more about NextGen Real Time Edits go here.

NextGen Healthcare clients, Join us on our free monthly telephone call and webinar: “NextGen Real Time Edits”