Smarter Week

How to automate it

How to automate “fix claim errors and rejections before they go out”

Here are 2 ways to spend less time on this, best first. Each comes with steps you can follow today.

60 min
typically, every day
55%
of the time can be automated
Some setup
to set up

Fix 1 of 2

Software featureBest fix

Let the claim scrubber catch errors before claims go out

Clearinghouse and PM claim edits check codes, modifiers and payer rules before submission, so you fix problems once instead of working rejections later.

Typically saves about 40% of the time3 h to set up
  1. 1Pull your top 10 rejection reasons from the clearinghouse.
  2. 2Turn on or build edits for each one (Waystar, Availity, Experian Health or your PM system).
  3. 3Fix the cause upstream (registration, charge entry) where you can.
  4. 4Review edit hits weekly.

Tools: Waystar · Availity · Experian Health · athenaOne or your PM system

Fix 2 of 2

Process fix

Track the top denial reasons and fix them at the source

Most denials come from a few repeat causes such as eligibility, missing auths or coding. Fixing those upstream prevents work instead of redoing it.

Typically saves about 30% of the time2 h to set up
  1. 1Run a report of denials by reason and payer for the last 90 days.
  2. 2Pick the top three causes.
  3. 3Fix each at the source with the front desk, clinicians or coders.
  4. 4Recheck the numbers monthly.

Tools: Your PM system or clearinghouse reports

Who does this task

Roles in our library that list this as one of their common tasks. Each guide covers the rest of that role’s week.

Medical billing / coding specialist

HourLeak · the 8-minute work audit

How many hours does this cost you?

The free 8-minute check works out where your week goes and gives you your top fixes. The team scan does the same for everyone and adds it up, so you know which leaks to fix first.

Take the free check Scan my team, $49

Answers are anonymous. Leaders only see team totals.

Other common tasks for Medical billing / coding specialists