Claims payment optimization
Every claim that is not paid on the initial medical billing submittal wastes valuable time and money. The Medical Group Management Association (MGMA) estimates that the average cost to re-work a claim that has been rejected or denied is $25 for each claim. If the average cost of rework is $25 per claim and your practice has about 100 claims each month that require rework, then it costs your practice an average of $2,500 a month to work unclean claims. This could cost your average medical practice an estimated $30,000 per year.
Many rejected medical claims are resubmitted numerous times, often without their errors being addressed or remediated. This creates the potential for further revenue loss, such as when a rejected claim needs to be reworked beyond its timely filing deadline. In addition, claims submitted inaccurately can result in legal issues. If your medical practice submits too many improperly filled out claims, you can be flagged for potential fraud and abuse. The U.S. Department of Justice (DOJ) enforces laws, such as the False Claims Act and Anti-Kickback Statute to crack down on coding abuse like improperly used modifiers, overcharged services, and more. Fraudulent claims can cost your medical practice thousands of dollars in fines.
edgeMED leverages our 40+ years of revenue cycle management expertise to eliminate costly mistakes in the billing process, such as upcoding, downcoding, and inaccurate claim information. We ensure accurate billing and coding to protect your medical organization from fines and inefficient billing practices.
Generate clean claims
Most practices struggle with submitting a clean claim as providers are busy inpatient care and can’t provide more attention to medical billing. A high number of medical claim rejections and denials will directly affect your practice revenue. edgeMED’s revenue cycle experts submit a maximum number of clean claims, managing a clean claim percentage rate above 95%.
Medical claims are some of the most valuable sources of data for healthcare organizations. All-payor claims contain detailed diagnosis and procedure information for any billable patient visit. Healthcare organizations can use this claims information to:
Trace referral patterns
Improve population health
Pre-audit claim fields automatically for potential errors before submission to a payer
Accelerate their go-to-market strategy
Expedite a payer’s claims processing turnaround and potential payment time frame
Improve the practice’s accounts receivable
It can be difficult to do all this without fully understanding medical claims data. edgeMED ensures the appropriate reimbursement for providing medical services and procedures is secured from patients and payers.
People + technology
We leverage our expert team and intelligent technology to ensure an optimum percentage of clean claims and build a continuous process.
Ensure correct and updated patient information on medical billing claims
Verify patient eligibility and benefits at-least two days prior to the date of service
Procedure authorization at-least five days prior to the date of service
Follow carrier specific coding guidelines
Ensure correct modifier usage
Undertake quality checks prior to submission
Detailed medical documentation
We’re the experts you can count on
One of the most effective strategies for boosting your clean claims rate, a vital metric in the realm of medical billing, is to entrust the task to a proficient and experienced revenue cycle management company. By partnering with edgeMED, you gain access to a wealth of expertise and resources that can make a substantial difference in your revenue cycle. Not only do we ensure strict compliance with regulations, but we also specialize in generating clean claims by proactively identifying and rectifying potential errors before they ever reach the submission stage. This proactive approach significantly reduces the likelihood of delays and denials in the claims process, facilitating a swifter and more seamless receipt of payments for the healthcare services your practice provides.
Our team of experts is here to guide you, answer your questions, and illuminate the path toward enhancing your clean claims rate and, ultimately, your practice's financial success.
Supercharge your practice!
Create efficiencies, streamline your medical organization and get paid more.
U.S. government entities
edgeMED is a U.S. Government Services Administration (GSA) contract holder (contract #47QRAA22D00E8) that provides federal and state governments with revenue cycle management services. Access to edgeMED ordering information, terms and conditions, pricing, and the option to create an electronic delivery order, are available to government entities through GSA Advantage!® at GSAAdvantage.gov.