RCM tip of the day: Review claims midcycle and before sending to payer

Claim edits should be customized to each payer's requirements and formatting, and hospitals should update payer rules frequently, according to Rick Childs, vice president of revenue cycle management at Rome, Ga.-based Floyd Medical Center.

Mr. Childs shared the following tip during a webinar with Becker's Hospital Review:

"Hospitals should review claims both midcycle and before the claim is sent to the payer to look for errors and make appropriate edits, according to Mr. Childs. He said edits should be very customizable to the payer, since each payer has different requirements and formatting preferences for claim forms. Oftentimes, a revenue cycle service provider can work with hospitals to build in these custom edits and author new rules based on learned payer behavior. This partner should also update payer rules frequently and before the effective date, according to Mr. Childs.

"He recommended reviewing edits on an annual basis to look for inefficiencies. 'You can't just build them and forget about them,' he said. 'You need to keep monitoring what those edits are doing for you.'"

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. 

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