Claim Scrubber Optimizes Radiation Therapy Claims Reimbursement

Coding claims is tricky. TRICKY

Radiation oncology billing is especially difficult because of the planning and staging processes that occur prior to treatment. On a bad day a coder can create future problems that are difficult to remedy.  Fortunately, Iridium Suite offers a safety net to help you avoid the pitfalls of improper coding.

A claim scrubber is a built-in editor, like spell check, except it is automatic. Iridium Suite medical system software features a scrubber that has many capabilities, so a biller can be confident that many billing violations will be caught by the claim scrubber before the claim is generated.  The claim scrubber is present and active in the background during billing work, whether during the importing of charges from outside systems (such as record and verify systems or EMR's/EHR's) or while manually coding charges.

Here are a few examples of the functions of Iridium Suite’s claim scrubber:

The claim scrubber offers suggestions for converting old, outdated codes to newer ones, or requests permission to add a modifier to an E & M (evaluation and management) code that conflicts with other codes billed the same day, such as 99204 with 77263.  The biller has the option of re-evaluating the code and overriding the warning edit or allowing the scrubber to change it.

The claim scrubber sets a warning status on service lines that may be correctly coded but which conflict with other services according to NCCI (National Correct Coding Initiative) edits. A pop-up window shows the NCCI conflict and rule regarding the services billed. The biller has the option of choosing to override the warning status or the biller can change the date on the service that is being billed to avoid the conflict. The service line may also be deleted and a more appropriate service can be coded.

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PQRI/PQRS is a potential ‘miss’ on any patient having Medicare or Medicaid.  If a medical practice activates the PQRS scrubber, then the scrubber is configured to automatically request that the physician sets up PQRS measures for each patient whose treatment qualifies for PQRI. The claim scrubber also recognizes which billing codes are potential PQRS denominators and automatically suggests the PQRS numerator codes that should be added to the claim. The biller simply accepts these suggestions and the claim scrubber automatically adds the proper PQRS charge codes to the claim.

In addition, the Iridium Suite claim scrubber makes every radiation oncology biller’s life better by automatically adding up the patient’s daily treatments and applying the management code 77427 with its corresponding dates. This feature is a fantastic time saver and ensures that this often-forgotten code is billed out properly.

Iridium Suite’s claim scrubber is only one of the many ideally designed tools integral for the best radiation oncology medical practice billing software available. It saves time and money and prevents potential errors that delay receipt of your claim reimbursement.