Reducing Claims Denial with PHIMED PhyGeneSys Solution

As a healthcare provider, you know the frustration when medical claims are kicked back. Not only does it cost you time and money to analyze and resubmit the claim, but denials can also lead to lost revenue and decreased patient satisfaction. Minimizing claims denial is arguably the biggest challenge facing medical practice management. It’s no wonder that many claims are rejected for coding errors, considering there are around 70,000 ICD-10 codes and approximately 12,300 CPT codes, totaling around 82,300 medical codes currently in use. Facing that level of complexity, medical coders benefit greatly from automated software, such as PHIMED’s PhyGeneSys.

PhyGeneSys integrates automation, accuracy, and continuous improvement into your claims submission process, ensuring optimal reimbursement rates and streamlined operations. In this blog post, we’ll discuss how you can minimize costly claims denials using our solution.

Preempt Denials with Clean Coding and Policy Compliance

As mentioned, the primary reason for denied claims is coding errors, which can occur due to lack of information, incorrect diagnosis codes or improper use of modifiers. The key is to validate accuracy prior to claims submission. PhyGeneSys pre-claim scrubbing and pre-billing review features work together to reduce overall denials. Ensure that your claims are accurately coded and policy compliant, and you’ll get a head start on maximizing revenue by mitigating denials from the onset.

Easier said than done? Not really. PhyGeneSys Error Check, the initial pre-claim scrub will notify the user of any potential issues with the respective Incidents. Users are alerted to errors when critical data is missing from a charge required to be included on a claim. Additionally, error alerts can be customized according to the users’ needs. With PhyGeneSys, you will have the necessary tools to submit clean claims, reduce denials, and enhance your bottom line. In fact, PhyGeneSys boasts a first-time claim approval well above the industry average.

Streamline Your Claims Appeals Process

Even with accurate coding and following the rules, a denied claim can still happen. In such cases, PhyGeneSys simplifies the appeal process. PhyGeneSys provides a proven workflow, easy access to source documents, appeal templates, and key denial inventory reporting metrics, and permits streamlined denial intervention for rapid revenue recovery. The system also tracks the appeal process, keeping you updated and ensuring your claim is filed again as soon as possible.

Data-Driven Continuous Improvement

PHIMED is committed to continuous improvement, utilizing advanced analytics and reporting that leverage machine learning to identify workflow weaknesses and implement modifications to reduce future claims denials. With PhyGeneSys, you will have access to data-driven insights further optimize your claims submission process.

The system collects data on every claim submitted. This allows for real-time tracking of claims, identification of trends, and receipt of alerts regarding potential issues before they result in denials. What’s more, our team of experts will collaborate with you to review your claims data, pinpoint areas for improvement, and develop a tailored plan to optimize your claims submission process. Now you have the tools – and partnership – to reduce denials, maximize revenue, and streamline your operations.

Take the Step Toward 100% Claim Accuracy

By integrating automation, accuracy, and continuous improvement into your claims submission process, your revenue cycle becomes more manageable and predictable. With our pre-claim coding validation, automated claims appeals process, and data-driven continuous improvement, you will establish evidence-based, best practice approach to revenue collection.

PhyGeneSys features extend well beyond claims submissions. You’ll greatly enhance patient communications, patient intake, records, and appointments, while enhancing patient experience, just to name a few. And remember: onboarding a system like PhyGeneSys means relieving your staff of the repetitive, tedious details that are driving valuable associates away from healthcare. Your finance department and coding staff will thank you.

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