NextGen Charge Review Rules Engine

The NextGen Charge Review Rules Engine combines custom and specialty-specific rules with automation to review and correct charge data from your EHR before charges are passed to your PM system. Reduce operating costs, capture missed revenue, and accelerate insurance payments.

Benefits of the NextGen Charge Review Rules Engine

Gain an automation partner for billing

A rules engine is the application of artificial intelligence to medical billing. Our team translates your staff’s knowledge into customized rules for automated charge review. The rules engine finds the same coding issues your team would have to find manually.

Save time

The NextGen Charge Review Rules engine fixes billing errors at the front end of the revenue cycle—between the EHR and the PM system. This saves time by reducing need for later-stage manual review and corrections and preventing denied claims.

Get paid faster

NextGen Rules Engine finds and automatically corrects a significant portion of errors. It increases the accuracy of information delivered to the PM system, which in turn increases the likelihood your practice will send out clean claims and get paid faster.

Decrease your staff’s repetitive workload

Based on experience, about 75% of charges pass through all rules and go directly into the PM system or are auto-corrected and then delivered to the PM system—these charges don’t need any review or correction by your staff.

Free staff for higher-level tasks

Free your staff to focus on tasks other than location of billing errors, such as management of pre-authorizations, patient pay collections, or denials. Elimination of repetitive tasks and opportunities for higher level problem-solving may reduce stress and enhance workplace motivation.

Capture missed revenue

Medical billing codes are automatically reviewed against specialty, custom, and regulatory rules. This supports compliance with payer requirements, detection of errors, reporting of quality measures, and compliance with requirements under value-based contracts. Increased coding accuracy helps ensure full reimbursement.

How the NextGen Charge Review Rules Engine works

75% of charges pass through all rules and go directly into the PM system or are auto-corrected.

Charge data delivery

The NextGen Charge Review Rules Engine sits between the EHR and the PM system. Charge data is fed to the rules engine from the EHR.

The NextGen Charge Review Rules Engine reviews and corrects charge data.

Automatic review

The rules engine automatically reviews every charge to ensure coding accuracy. If coding discrepancies are not detected, the charges pass immediately to your PM system.

Accelerate insurance payments with NextGen Healthcare Rules Engine.

Charge error resolution

If an error is identified, the rules engine either automatically corrects it, or if in-depth review is needed, sends it to billing staff for resolution.

Tap into the power of a full rules engine for success in your practice.

QUICK REVIEW

Understanding automated charge review

Here’s a short overview of the automated charge review workflow and how it enhances medical billing—plus some great examples of how medical practices have benefited from this remarkable medical billing solution.

With the NextGen Charge Review Rules Engine, we were easily able to scale up with value-based contracts. The value of the Rules Engine is unprecedented; in fact, it’s a necessity for any organization with risk-based contracts.

Kelly Macken Marble

Chief Executive Officer South Bend Clinic

Technology to optimize the revenue cycle

Alex Suarez, informatics specialist at Stuart Cardiology, discusses how the practice streamlines their revenue cycle and maximizes reimbursement with smart financial solutions.

The results speak for themselves

Our award-winning healthcare IT solutions become better each year thanks to the tireless efforts and ingenuity of our diverse team and insightful feedback from medical practices like yours.

Awards