The world of workers’ compensation (WC) is intricate, demanding, and often riddles medical billers, coders, and WC professionals with challenges that stretch resources thin. With pressure mounting to increase efficiency and drive down costs, it’s time to equip your WC program with innovative tools that can carve out new pathways to savings. The tool at the frontier? Rare Diagnosis Codes.
In a daring endeavor, our team at Adaptive Processing Solutions (APS) set out to validate the potential locked within RarityReview, a service designed to scour WC medical billing activities and fish out Diagnosis Codes that seldom make an appearance. These codes, glamorous in their scarcity, often turn into untapped reservoirs of cost savings for clients.
The Approach:
Using a highly analytical approach, we dove into the deep end:
- Auto Deny Bills: We zeroed in on bills featuring diagnosis codes with a negligible likelihood of having ties to legitimate WC injuries. Such bills fitting the Auto Deny bill are systematically denounced, returned to the provider, or filtered out via medical bill repricing.
- Manual Review Bills: We pinpointed bills flecked with diagnosis codes that stood a high chance of irrelevance to WC injurious claims. These bills, earmarked for Manual Review, are routed to seasoned adjusters or clinical evaluators before the nod for payment is given.
A client’s real medical bill activity furnished the data for this intricate analysis. By dissecting their allowed medical bill payments, we uncovered the prevalence of “Absolute Rarity” and the fusion of “Absolute Rarity and Strong Rarity” diagnosis codes.
The Revelation:
The analysis unearthed some striking numbers:
- Total Bill Review Allowance: A colossal sum exceeding $200 million.
- Auto Deny Bill Configuration: Targeting Absolute Rarity diagnosis codes alone harvested an auto-deny rate of 0.5%, catapulting annual savings to around $1 million, sans the need for manual review.
- Maximizing Savings: When RarityReview detects primary and secondary ICD codes mingled with Absolute and Strong Rarity codes on the same bill, the savings skyrocket, confidently leaping to an estimated $16 million!
The Power is in Your Hands:
RarityReview does more than analyze; it personalizes. Each organization dictates which bills get the green light for auto denial and which warrant manual scrutiny. At APS, we tailor-make each RarityReview program to work seamlessly with your requirements.
Have you discovered effective tactics for pinpointing rarely billed Diagnosis Codes in your billing or audits?
Your experiences with rare codes are invaluable and could help light the way for many in the WC billing ecosystem. Share your insights and methodologies, and together, we can unravel best practices to enhance the intricate art of medical claims processing in the realm of workers’ compensation.
For more information on how RarityReview can revolutionize your WC processes, visit Adaptive Processing, or call 855.282.1476 today!
