Physician Practice Services Chooses Info-X to Improve Claims Management for Physician Groups

December 16, 2003

Info-X, a provider of coding compliance solutions for hospitals and physician groups, announced that Physician Practice Services (PPS), a professional billing and practice administration consulting firm, has implemented its Veri-Claim(TM) software.

Physician Practice Services processes thousands of Medicare and commercial claims for approximately 90 physician groups representing more than 500 physicians, including major faculty practices like New Jersey’s Monmouth Medical Center Faculty Practice Plan and hospital based-physicians at Newark Beth Israel Medical Center and Saint Barnabas Medical Center. The billing services company uses Veri-Claim to detect coding and compliance issues with these claims prior to payor submission. During a three month evaluation of the HIPAA-compliant software, Physician Practice Services reduced its claims denials by 80 percent.

“Like many billing services companies, claims processing is a critical source of our revenue,” said Tony Esposito, executive director for Physician Practice Services. “We realized the importance of having an effective claims scrubber and selected Veri-Claim over other leading vendors for a number of reasons. First, the local medical review policies (LMRP) are updated on a monthly basis – ensuring that we have access to the most up-to-date coverage information. Second, Veri-Claim’s Web-based reporting is so flexible that it enables us to view a statistical summary report at the batch-, physician group- and individual claim-level. And finally, the system is easy to implement and easy to use. Within a few hours, our staff was using Veri-Claim to scrub claims.”

On a daily basis, claims files are uploaded from PPS’ practice management system to Veri-Claim through a secure Web browser. Utilizing Info-X’s EditEngine(TM) technology, Veri-Claim “scrubs” the claims to detect claim coding and compliance issues, and detailed reports are generated which explain the reason or reasons for possible claims denial.

Physician Practice Services can then use Info-X’s Web-based tools such as CodeViewer(TM), a suite of coding reference tools, to research any identified issues. Correcting these issues prior to payor submission accelerates the reimbursement cycle for Physician Practice Services by improving their “clean claim” rate and reducing labor costs associated with following up on rejected claims.

Was this article valuable?

Here are more articles you may enjoy.