Upcoming 2024 Claims Editing Projects

Work has started on new claim edits and claim auditing projects that will address several correct coding issues. This process will continue throughout 2024.

Some of the key topics being reviewed for possible future edits include, but are not limited to, the following:

• Drugs and Biologic Edits: A subset of drugs administered in the physician office will be identified for application of edits covering such items as dose and dose frequency limits per FDA prescribing information, age restrictions, and treatment contraindication.
• Lab Claim Editing: Reviewing and auditing lab panel coding/billing.
• DME/SNF/Home Health Claim Editing: Addressing correct billing and coding issues.
• Genetic Testing: Reviewing to evaluate billing compliance with industry standards, and
• Payment Accuracy Edits: Covering such topics as preadmission testing, observation, radiology coding and billing, physical therapy coding and billing, inpatient hospital transfers, maternity coding and billing.

As the work progresses into 2024, additional information will be released in Provider News, including details, timing and specifics for the edits and audits. Watch for additional updates after the new year begins.