When Claims Edits Pile Up: What One Hospital Learned About the Cost of Waiting

Struggling with unresolved claims edits and growing billing backlogs? In this post, we explore how one hospital cleared a mounting queue of claims edits—and why addressing these issues early can protect your revenue cycle. You’ll learn common challenges behind edit delays, strategies for sustainable resolution, and how to balance automation with expert oversight.

What are the Impacts of Claims Edits?

Claims edits are meant to protect revenue by flagging potential issues. But when not managed effectively, they do the opposite—stalling cash flow, increasing rework, and frustrating your staff.

From front-end billing edits that stop claims before submission to post-bill denials that demand deeper analysis, edits can easily become a moving target without a structured approach to triage and resolution.

What Causes Claims Edits to Pile Up?

Even high-performing coding and billing teams run into problems like:

• Unclear ownership of edits
• Overreliance on automation tools
• Lack of dedicated staff for edit resolution
• Limited visibility into recurring edit patterns

What starts as a technical delay can quickly lead to bigger financial consequences.

What Makes Edit Management Sustainable?

Handling a backlog is one thing—keeping it from returning is another. The organizations that manage edits most effectively tend to share a few strategies:

1. Routine Worklist Triage

Establish a regular rhythm for reviewing and addressing open edits, rather than reacting once issues grow.

2. Defined Accountability

Everyone on your team should know who owns what. This reduces delays and ensures accountability.

3. Balanced Automation + Human Review

Technology can speed up simple edit resolution, but nuanced cases—especially those involving coding or documentation—still require human judgment.

4. Trend Monitoring + Training

Recurring edits offer a chance to train upstream—whether it’s documentation coaching or refining billing system rules.

Why Many Organizations Bring in Outside Support

Let’s be honest: most internal teams don’t have the bandwidth to manage edit resolution and keep day-to-day operations running. That’s why many hospitals and health systems work with outside partners—temporarily or long term—to keep claims edits from slowing everything down.

Health Information Associates supports organizations in resolving billing edits and denials, triaging worklists, and putting sustainable processes in place. Whether it's clearing a backlog or supporting ongoing maintenance, HIA helps revenue cycle teams stay ahead of the hold-up.

For more than 30 years, HIA has been the leading provider of compliance audits, coding support services and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities. HIA offers PRN support as well as total outsource support.

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.