Payer Rules Maintenance
Payer rules maintenance, achieving “clean claims” and maximizing revenue: they are related. How well you maintain your payer rules database and ICD codes (ICD-9 and the future ICD-10) can significantly impact how effective and timely you are in recognizing revenue. We know this is the core need of any medical practice, regardless of specialty. Our medical coding software has been designed to maximize your ability to capture revenue.
AdvancedMD Software Keeps you Abreast of New Medical Rules & Billing Changes
It’s difficult at best, for the busy practice to keep on top of new medical rules, coding and requirement changes as well as ICD* updates. It’s almost like you are in an endless battle to capture your revenue. Coding rules and format requirements keep changing, on top of the challenges relating to ICD-10 updates. Payer billing changes increase the rejection rates on submitted claims, which slows the outflow of your reimbursements. The net effect of this tactic on most medical practices is they only capture between 60 and 70% of what they submit to payers.
The only way to beat these odds is to constantly keep watching for new coding rule changes and ICD code updates. Most practices aren’t in a position to dedicate office resources to that function. The AdvancedMD web-based model addresses new rule changes and ICD code updates, continuously and automatically.
Benefits of AdvancedMD Software: Continuously Updated with the Latest Industry Codes, New Medical Rules & Countless Billing Changes
Clean Claims Submission Process = 95% Claim Acceptance
Our clean claims Claim Inspector™ not only checks your claims against industry coding guidelines, such as LCD, NCD, CCI, HIPAA, LMRP edits and payer-specific requirements, it also uses proprietary logic to help ensure your claims are error-free prior to submission. Our process helps you reduce denials and costly resubmits.
Nimble, Faster Response Time
Office- or server-based software vendors simply cannot react as fast as a web-based vendor. In-office software is isolated making it impossible to adapt to medical coding changes as quickly as AdvancedMD can. And when they do make enhancements to their rules database, they can’t release them to their customer base as quickly as we can. It pays to go web-based. As the new ICD-10 codes are introduced, consider the disaster awaiting medical practices using in-office software systems that don’t facilitate immediate system updates.
Shared Learning, Better Collections Success
Because more than 15,000 providers share the same claims processing rules database, AdvancedMD product managers are able to constantly monitor claims submission results across all clients, which enables the AdvancedMD team to quickly pickup coding rejection trends that indicate a rule change has taken place. The situation is quickly researched, the engineering team makes the adjustment, and in short order, the new enhancement is updated on the AdvancedMD production servers, where all of our customers can benefit instantly. This is why we are able to guarantee that our software application suite reduces the average claims rejection rate on first submissions down to less than 5%, from the industry average of 30%. What this means for the medical practice on AdvancedMD is greater revenue capture, faster. What our customers gain in terms of additional annual revenue more than covers the annual subscription fee for our web-based software.
Searchable, Easy-to-use Code Index
AdvancedMD medical coding software includes an online index system that is searchable and easy-to-use. You can search the software index for medical codes and coding needs by keywords or by range. Once you have located a specific keyword or range you will see code details and descriptions that will help you make sure that you have identified the right medical code or codes for the procedure. Imagine a web-based software system with automated lookups on CPT codes! With the AdvancedMD system you may never want to use a code book again!
Free Online Access to Latest Codes
With AdvancedMD software you gain online access to the latest medical codes, including ICD-9 codes (and ICD-10 when available), CPT codes, and HCPCS codes, right from your medical billing system, accessible via a web browser from anywhere, at anytime. We provide easy on-screen coding lookups and quarterly updates—all at no extra charge.
*ICD: The cause-identifying number classified in the Ninth Revision of the International Classification of Diseases adopted in 1979.