Best Practices for Tracking and Resolving Claim Edits

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The 2022 NAHRI Leadership Council Survey Part 2 examines claim edit patterns, pre-billing processes, and top payer trends.

In addition to clinical areas, the last two years of the COVID-19 pandemic also introduced massive disruption to the revenue cycle, skewing billing processes and historical claim edit trend analysis. Even so, revenue integrity leaders can confidently say that reimbursement and denials are still two significant drivers that set the stage for tracking, resolving, and reporting claim edits.

In the Spring 2022 NAHRI Leadership Council Survey, Custom Edits—Creation and Workflow, 100 leaders, including revenue integrity, health information management (HIM), and coding directors and managers primarily from acute care hospitals and health systems with 500+ beds, described their custom edit processes and workflows and key factors that drive custom edits, noting that accurate reimbursement is the most important requirement for a custom edit.

At the July 2022 NAHRI Leadership Council Meeting, a virtual roundtable panel of revenue integrity leaders examined the survey results, sharing their own top challenges and best practices for tracking, resolving, and reporting claim edits.

Download the latest research report to hear what they had to say on topics such as:

  • Tracking how edits affect key metrics and processes
  • Reviewing and resolving claim edits
  • Keeping tabs on payer claim edits and denials
  • Payer edit volumes
  • Reporting claims edit data to payer contracting staff
  • Future focus: Proactive partnerships, automation, and detailed data reviews