Medicaid and Medicare managed care claims play a crucial role in many organizations' financial performance. Billing editors may be involved in making sure these claims are processed correctly.
Jeff Means and Sara Roberts of Colburn Hill Group: Nationally there are very few billing editors and regionally there are even less. Ensure your claims editor is configured to handle managed Medicare and managed Medicaid claims as their own claims class. Simply following the commercial claims edits or even just the Medicare or Medicaid edits is not sufficient. Often edits need to be run in a specific sequence to ensure the right outcome is achieved on the final bill.
To learn more about Medicaid managed care, access this story from Becker's Hospital Review.
If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.
More articles on healthcare finance:
How Partners HealthCare's miscalculations altered Medicare payments nationwide
Dana-Farber's Medicare funding at risk due to overreliance on Brigham and Women's
Average claim denial rate for large hospitals, by region