title: Is your claim editor really working?
abstract: An analysis of 15 selected areas from publicly filed Medicare outpatient claims was performed to test the accuracy of claim editors. The analysis disclosed that in 2004, U.S. providers lost more than dollar 327 million of reimbursement due to errors in claims. Reimbursement was deemed "lost" only where it was obvious that billing errors had been made. Claims that included pathology exams had the greatest potential for lost revenue, because they often failed to account for the presence of specimen-removal procedures.
authors.affiliation: Cleverley and Associates, Worthington, Ohio, USA.
authors.forename: Lauree
authors.initials: L
authors.lastname: Handlon
authors.forename: William
authors.initials: W
authors.lastname: Cleverley
mesh_terms: D017598:Efficiency, Organizational; D005377:Financial Management, Hospital / Q000379:methods*; D007344:Insurance Claim Reporting / Q000592:standards*; D012051:Reimbursement Mechanisms; D014481:United States