Coding, Classification & Reimbursement

QA of claims

  • 1.  QA of claims

    Posted 04-28-2019 16:06
    HI There-working on a project in regards to clean claims. I was reaching out to see what steps organizations are taking to proactively make sure clean claims are submitted for reimbursement? Is there a specific team that is designated for this task? Any background would be great. Thank you!

    Meagan Tippett
    Medical Records Supervisor

  • 2.  RE: QA of claims

    Posted 04-29-2019 11:23
    Good Morning!
    I worked with a very large client years ago shortly after APCs came into being that did but a team in place to review all outpatient claims before they went out the door.  This team stayed in place for around 5-8 years depending on their various edit responsibilities.  The coder who was skilled in outpatient coding and APC assignment would review for modifiers, status indicators, revenue code assignment, NCCI, LCD edits and provide feedback to the coding and billing department.  The claims were all "repaired" before they were released to the MAC/providers.  This was for all their outpatient claims including any 3rd party payers.


    Cheryl Bowling, RHIT, CCS, CHC, C-CDI
    Client Compliance Partner

  • 3.  RE: QA of claims

    Posted 05-10-2019 15:07
    When APC's first came out back in 2000 a new position was created at my hospital for an APC Coordinator.  I took the role and that was one of my duties to run a report and review all outpatient accounts prior to claim release.  Now we use Epic and the work of clean claims is divided among many teams.  Much of the work is done by non coders and I do see errors in what they process.  I wish we could utilize the skills of coding professionals in more of these areas so that valid clean clams could be the rule.

    Lisa Withers
    Coding Qi Compliance Auditor and Trainer