What’s Medical Billing Got to Do With World Series Baseball? … More than you think.

When a batter swings and misses the ball, it’s a strike. Three strikes, is an out.

Once a claim is denied, a biller usually gets three tries to appeal the decision. If those three tries are unsuccessful then you are “out” your reimbursement.

If a runner knows the ball is coming and he might be out, he slides to

miss the tag.

A smart biller is aware of codes that may be denied and will obtain a pre-approval from the payer.

First Base- Real Time Eligibility

Verify patient

coverage before rendering services.

How does your medical practice $core? With Iridium Suite Practice Management Software

Check it out: www.iridiumsuite.com

Third Base- Electronic

Claims

System monitors response by payers to

quickly identify rejected claims and provide

proof of timely filing.

Second Base- EHR data transfer via HL7 imports charge data

eliminating manual entry. All charges are scrubbed against CCI edits and other customizable coding rules to produce clean claims.

Home- Payments received and ERAs are

automatically adjudicated with little user interaction.

PATIENT ROSTER

Payer Response

Date Details

Accepted

Rejected

Important Stats: In baseball, “Batting 1000” is perfect and impossible. Monitor your claim collection

rates to ensure they are within the range of industry standards. Pitchers want the lowest Earned Run Average and you should strive to keep your

denied claims to a minimum as well.