Procedure Code Analysis

If your HCPCS, ICD-9 and CPT codes aren’t up to date and accurate, you're practice is losing thousands of dollars in denied and down coded claims. This is one of the most severe problem areas for most practices.

Inaccurate codes delay payment for months. Insurance companies utilize invalid codes as an excuse to place claims in “review,” a process that can result in summary denial of the claim or opportunistic down coding. When a procedure code is invalid, the claims payer has the discretion to use the description given as a guide to identify several possible codes and select the lowest value code for payment. You are never advised of the error and never learn of the underpayment.

If just 10% of your codes are invalid or inaccurate, and each error costs you $50 per claim, your practice could be losing $50,000 per year due to down coded payments.