Revenue Management Edits
Revenue Management Edits
There are several types of edits with Revenue Management:
- ANSI Edits – included at no cost
- Common Edits – included at no cost
- User Defined Edits – included at no cost
- Medicare Policy Edits – Annual subscription required
- Check DX codes – Annual subscription required
- Check CPT codes – Annual subscription required
- Global Periods – Annual subscription required
- CCI Edits – Annual subscription required
Most of the edits can be turned on or turned off based upon the insurance carrier.
ANSI Edits – ANSI edits are included in Revenue Management free of charge. These edits are displayed on the claim preview window. The implementation guide determines ANSI Edits. Typically, the ANSI edits will cause either the file or claim to be rejected.
Common Edits – Common Edits are included in Revenue Management free of charge. These edits are displayed when checking claims. The Common Edits are a predefined set of common checks loaded when the Revenue Management Database is created. The Common Edits can be edited, imported, or exported. These edits are designed to catch common data entry mistakes. The edit message text and the edit message level can be edited and changed.
User Defined Edits –Revenue Management gives users the ability to make user defined edits free of charge. These edits are displayed on the claim preview window. User defined edits are made in the configure edits editor. User Defined Edits can be edited, imported, or exported. These edits are designed to catch common data entry mistakes. The edit message text and the edit message level can be edited and changed.
Medicare Policy Edits – Medicare Policy Edits are available with Revenue Management for an additional cost. These edits check the Procedure Codes on a claim to see if they are listed in the coverage topics selected in preferences. If they are listed, the Diagnosis Codes on the claim are checked against the supported/not supported list of diagnosis codes for the coverage topic. The coverage topics are selected in the preferences inside of Revenue Management.
Check Diagnosis Codes – The Check Diagnosis Codes edits are available with Revenue Management for an additional cost. If enabled, the Diagnosis Codes on a claim are checked against the valid codes stored in the MCD database.
Check CPT Codes – The Check CPT Codes edits are available with Revenue Management for an additional cost. If enabled, the Procedure Codes on a claim are checked against the valid codes stored in the MCD database.
Global Periods – Global Period edits are available with Revenue Management for an additional cost. A global Period is when a specific procedure is performed, the follow up visits or procedures are considered to be part of the original procedure. The length of most Global Periods is same day, ten days, thirty days, sixty days, or ninety days from the date of the original procedure.
CCI Edits – CCI Edits are available with Revenue Management for an additional cost. These check for mutually exclusive codes (ones that cannot normally be billed together) and comprehensive/component codes (also called "bundled" codes, this means that one code is considered to be part of another code, and they cannot normally be billed at the same time).