Q&A: Applying claim edits

Q. What is the recommended timeframe for applying edits to a claim?

A. Most providers will agree that waiting until claims submission to apply edits is not a good idea. Doing so will delay billing and impact payment—not to mention cash flow. The best time to apply code edits is when the account is coded. Because certified coders have access to medical record documentation, when an edit occurs, they are in the best position to evaluate the documentation to determine whether the following are true:

• Modifiers are allowed for the type of edit
• The documentation is complete enough to support a modifier

For more information, see Medicare Billing Edits: A Guide to Regulation, Research, and Resolution.

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