Revenue Cycle Management

Optimize Claims with Denial Defender^®

After your charges are entered, HealthFusion's Denial Defender^® will assist you in optimizing the claim to avoid rejections and denials.

The claim is compared against a sophisticated database of standards that contain millions of edits designed to avoid health plan rejection and denial. To avoid denials, Denial Defender^® from HealthFusion^® verifies modifier usage, checks for CCI bundling edits (CMS' National Correct Coding Initiative), determines code validity, displays Relative Value Units (RVU), validates pass-through items, and verifies medical necessity. In addition, Denial Defender will alert you real-time if any charges entered into claims are inconsistent with the current Medicare coverage guidelines.

With Denial Defender, Know that Your Claims Are Ready:

• The diagnosis code is valid for the date of service billed.
• When diagnosis code is limited as a secondary diagnosis only.
• The diagnosis code is appropriate for the gender and age.
• The procedure code is valid for the date of service billed.
• The procedure code is appropriate for the gender and age.
• The modifier is valid for the date of service billed.
• If an Evaluation and Management (E/M) and a procedure are reported, is an E/M modifier present?
• The modifier is consistent with the Current Procedure Terminology (CPT)/modifier crosswalk.
• If E/M, does the date of service fall within the global period of a previous procedure?
• If there are multiple codes, are codes sequenced appropriately based on RVU?
• Is there a Local Coverage Determination (LCD) or a National Coverage Determination (NCD) issue related to the procedure/diagnosis codes used?

By optimizing your charges as they are saved to the HealthFusion system, your practice will avoid denials and enhance reimbursement. Do not wait until the claim is rejected or denied – Get it right the first time and optimize your claim with HealthFusion's Denial Defender.