Most denials start before a claim ever reaches the payer. A code that does not match the diagnosis, a missing modifier or an expired authorization can stop payment. That is why our billers review charges before anything is billed.
- Diagnosis and procedure match. ICD-10-CM codes are checked against the CPT and HCPCS codes they support.
- Modifiers. Modifiers such as 25, 59 and the X{EPSU} series are reviewed so services are not bundled away.
- Payer edits. Each claim is scrubbed against the payer’s own rules and National Correct Coding Initiative edits.
- Authorizations and referrals. Required approvals are confirmed so the claim is not denied for missing paperwork.
When our review finds a pattern, such as one visit type that keeps getting denied, we share it with your team. Fixing the source is how the denial rate goes down for good, not just for one claim.
We keep your fee schedules current under CMS guidelines, so your charges match what you should be paid. If you want a deeper look, our billing audit reviews coding, documentation and payer performance across a sample of claims.