ClearCoder reference tool eliminates denied medical claims' risk

Durham 06 August 2001Physicians now have a way of checking to see if treatments will be covered by insurance through ClearCoder, a new personal digital assistant-based application. MDeverywhere, a provider of handheld solutions for physicians to improve efficiency and accuracy at the point of care, developed ClearCoder as a reference tool for the cumbersome Local Medical Review Policy rules set.


ClearCoder's effectiveness was validated by a recent independent return on investment (ROI) study completed by Superior Consultant Company, a national health care management and technology consulting firm. The ROI was performed in the pre-operative surgical department at a large teaching facility in the Southeast where 13 physicians utilised MDeverywhere's ClearCoder. Benefits realised by the department include a reduction of rework claims from 1219 to 813, resulting in a savings of $7808 per physician.

"Many insurance companies only pay for services which are considered medically reasonable and necessary", stated Alan Rubin, president and CEO of MDeverywhere. "Conceptually this makes sense, but the complex policies put a great burden on doctors to ensure they have chosen the right course of action and documented it properly for insurance reimbursement. To fall short of that will invariably result in a denied claim. The ClearCoder product eliminates the current gamble and as a result continues to build on our core expertise of delivering strong financial value to health care institutions."

ClearCoder offers doctors two ways to quickly determine whether a treatment is considered medically necessary. Clicking on a CPT procedure code displays all of the diagnoses which can be treated with the procedure. Clicking on an ICD9 diagnosis code displays all of the procedures that can be performed to treat the illness.

Because of its ease of implementation and strong financial return, MDeverywhere considers ClearCoder an ideal way to drive physician adoption of its core charge capture product, EveryCharge. MDeverywhere plans to market the ClearCoder tool to hospitals and large group practices across the United States.

MDeverywhere provides mobile handheld solutions which automate the physician encounter capture for medical group practices. The company earned an industry solution award from the Microsoft Healthcare Users Group, further proof that MDeverywhere is committed to providing practical, real world solutions for physicians, enabling them to provide the highest level of patient care.

MDeverywhere recently signed a partnership agreement with Experior Corporation, a health care information systems developer specialising in comprehensive practice management software solutions for physician clinics. The company also has agreements with MedQuist Inc., the TriZetto Group and Millbrook Corporation.

Superior Consultant Company specialises in Digital Business Transformation services which enable clients to thrive in the information-driven economy. Through its consulting, outsourcing, and e-solutions services, Superior provides all segments of the health care industry with the tools and strategies they need to effectively serve customers and capitalise on e-commerce opportunities. Superior's powerful e-health solutions, coupled with the company's 17 years of experience providing innovative solutions to the health care industry, enable clients to meet their fiscal challenges without compromising clinical quality.

Leslie Versweyveld

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