Root cause analysis of edits and an understanding of the relationship between the chargemaster and HIM/coding must be supported by overarching principles and best practices for edit management. Processes should be built around the timing of edits, applying edits across payers, and denial management.
A majority (57%) of healthcare payers and providers believe predictive analytics will save their organizations 15% or more over the next five years, according to a 2017 Predictive Analytics in Healthcare Trend Forecast by the Society of Actuaries. Despite the potential for savings, there are several roadblocks in the way.
Providers in some states may soon discover a big hurdle to clear when seeking to report a set of apheresis services after one MAC tightened up physician supervision requirements.
