Optimizing Your Billing System to Produce Clean Claims
|
|
- Gwenda Armstrong
- 8 years ago
- Views:
Transcription
1 Optimizing Your Billing System to Produce Clean Claims Chris Peters, ACL Laboratories Road to Billing Optimization Missing Billing Information Missing test modifiers Wrong billing address Insurance coverage lacking Data entry errors Failed Medical Necessity 1
2 ACL Laboratories Background The nations third largest hospital-based laboratory systems. Provide 21 million lab tests per year Parent Companies Aurora Health Care, Largest Integrated Health System in Wisconsin and Advocate Health Care the Largest Integrated System in Illinois Strategic Project Billing Optimization: To address these challenges our organization initiated a strategic project to enhance our billing systems to include: Auto fix & scrub claims based on custom rules. Automated eligibility checking Automate missing information requests. Create new online worklists that support claim scrubbing 2
3 Project Focus to Produce Clean Billing Claims What is a Clean Claim? A clean claim is one that does not require the Government or Commercial insurance carriers to intervene manually in the claim process and one that is not denied or returned to the provider for correction. Must pass all edits and is processed electronically. What are the Benefits of Clean Claims? Provides the Best Practice service to our patients & clients Allows the lab to submit the highest number of payable claims on the first try as soon as possible after the services are provided. Maximize cash flow & collections rate. Minimize claim re-work & rejections. Reduces the chance that the laboratory will come under scrutiny by government or other payers 3
4 Clean Claim Workflow Lab Orders Will Data Produce Clean Billing Claim? No Correct Data Electronic Billing System Yes Clean Claim Workflow Lab Orders Will Data Produce Clean Billing Claim? Yes No Correct Data Electronic Billing System 4
5 Top Clean Claim Challenges Missing Billing Information Medical Necessity Bad or Inaccurate Information Sent directly to lab from client office that By pass front-end system edits Data Entry Errors Wrong or missing test modifiers Inappropriate Duplicate Billing Payment rules that vary by payer/plan. Manual Processes Strategic Partnership Formed with In December, 2009 ACL signed a contract with the Rhodes Group to provide claim scrubbing software Fusion 100% claim scrubbing. Rhodes Group Proven Track Record in Building Clean Claim Scrubs for the Lab Industry. Fully integrated with our core billing system - Sunquest Clinical Financial Systems 5
6 Clean Claim Workflow Lab Orders Fusion Will Data Produce Clean Billing Claim? No Online Worklist to Correct the Data Yes Electronic Billing System Key Benefits of Rhodes Fusion Claim scrubbing software Flexible & Adaptive rule building for custom scrubs. Custom scrubs can be built using any orders or billing data element. Supports automation of missing information letter requests to ordering providers. Supports eligibility checking for top payers prior to billing Supports online worklists and automation to fix bad or inaccurate billing information 6
7 Tables/Scrubs Rules 70 + tables/ 200 active scrubs built to support Clean claim rules 100% Scrubbing Any lab orders or billing data field 200 active scrubs to support Each Scrub assigned an ID Automated Web Based Work lists Audit Review, Claim Check, Data Entry, Problem Tracking Paperless Billing with links to Lab requisitions Top Clean Claim Scrub #1. Is the Patient Eligible for Insurance? Lab Orders Fusion Is the Patient Eligible for Insurance? No Online Worklist to Correct Insurance Data Yes Electronic Billing System 7
8 Eligibility Rules National HIPAA Standards for Eligibility Checking HIPAA 270/271 (Health Care Eligibility Benefit Inquiry) transaction. Direct batch submission with top payers without transaction costs. ACL Goal check eligibility on 80% of all third party billing transactions. Eligibility Edits Claim Check Responses Validate: Patient s Date of Birth Patient s name Subscriber ID Another Payer is primary - The 271 acknowledged the patient and their eligibility but states that a different payer is to be billed first. Subscriber ID Auto updated from Claim Check Interface Policy number updated from payer database. 8
9 Eligibility Edits Skilled Nursing Medicare Logic - Checks the Medicare Part A status to determine to bill the nursing home or Medicare. Gender Updated - The correct patient gender information is provided based on the payer information. Address Updated - The correct patient address information is provided based on the payer information. Payer System Website Transmission Method Medicare IVANS Website: Medicare Inquiry Pro Software with auto 271 return Medicaid IL IL Medi Web Portal System IEC File Upload Medicaid WI Forward Health Portal Web Portal File Upload United UHC Web Portal File Upload Healthcare Connectivity Director Blue Cross/ Passport FTP Anthem IL Anthem WI Anthem EDI Web Portal Upload United Medical Passport FTP Resources Cigna Post n Track n track.com FTP Aetna Post n Track n track.com FTP Humana Availity Web Portal File Upload 9
10 Actual Medicare Eligibility Responses Another Payer to be billed first Part A coverage only Gender Updated Private Insurance Reponses Medicare to be billed first No Medical Coverage Date of Birth Updated Gender Updated 10
11 ACL Eligibility Checking -- Key Scorecard Results Insurance Denials for Eligibility are Down 80% 86% of all billing claims checked for Eligibility. 4,500 + accessions/ month auto fixed last month for the Policy Identification number Top Clean Claim Rules # 2. Does Lab Service meet payer payment rules? Lab Orders Fusion Does the Lab Service/Test Meet Payer Payment rules? Yes Online Worklist to Correct Claim Data N o Electronic Billing System 11
12 Top Scrubs # 2 -- Does Lab Service/Test Meet Payment Rules? Government vs Commercial Medicare /Government test payment rules well defined with quarterly updates Correct Coding Initiative (CCI) One or more of the tests on the claim is a component of another test on the claim. Services can not be billed together. Medical Necessity Edits (LMRP) (NCD) Local & National Polices No screening except by statue (Major source of DX faxes to Physician s office) Mutually Exclusive Edits (MEE) (2 comprehensive panels) Medical Unlikely Edits (MUE) services that are clinically or anatomically unlike for the vast majority of patients Top Scrubs # 2 -- Does Lab Test/Service Meet Payment Rules? Commercial Payers: Commercial payers Rules less defined (Medicare replacement/self funded Plans/HMO) Test payments rules vary and often change without warning i.e. bundle tests into a panel and pay lower panel rate. Constant revisions to keep lab billing edits current. Max Test Quantity Rules by Payer ( not always published) Tip: Review Insurance Remits to create new rules based on denials 12
13 Top Clean Claim Rules # 3. Is the Billable Party Correctly Assigned? Lab Orders Fusion Is the Billable Party Correctly Assigned? No Online Worklist to Correct Claim Data Yes Electronic Billing System Billable Party -- Scrubs Payer Assignment based on Policy ID. Useful for Commercial payers with unique numbering systems PolicyLike XOF% Then Blue Cross IL with Insurance Code: BlueIL Bill Client Account based on Client ID Useful for client that are 100% client bill Organization. ClientNumber: Client Bill Add or Delete Patient Billing Based on Payer This scrub automatically adds or deletes patient billing based on payer. Medicaid/HMO plans with no patient billing. Correctly Assign Insurance codes based on patient s state This scrub automatically assigns the correct payer insurance code based on patient state location.(wi or IL Medicaid, Blue Cross/Anthem) Correctly Assign Insurance codes base on Capitated insurance membership lists. Patient is member of a capitated insurance plan. This scrub integrates the membership database into the Scrub tables so that the correct insurance plan can be assigned. 13
14 Top Clean Claim Rules # 4. Is Required Billing Data Missing? Lab Orders Client Fax Automation Fusion Is Required Billing Data Missing? No Online Worklist to Obtain and Correct Claim Data Yes Electronic Billing System Missing Claim Automation Automated worklists for missing information requests sent to ordering clients. Options to autofax or requests to clients. Automated letters are sent every X days. The system tracks what letter has been sent 1 st, 2 nd or Final Letters. When a client returns the missing information the accession will be billed and auto removed from the Missing Information Letter Queue. If missing information is not returned after 3 faxes the client or patient will be billed depending on client setup. 14
15 Medical Necessity Multiple Edits 15
16 National Provider Identification Top Clean Claim Rules # 5. Can claim be Autofixed? Lab Orders Fusion Can Claim Data be Autofixed? No Online Worklist to Correct Claim Data Yes Electronic Billing System 16
17 Autofix Statistics Annual Count Autofix Patient Balance Billing 344,547 Autofix Cap Membership Billing 197,709 Assign Test Level Primary DX 163,806 Autofix Relationship Code for Responsible party 125,394 Autofix Payer 124,836 Autofix based on policy group 95,520 If a person could fix 2 of these per minute, these autofixes would represent 5 FTE S Key Scorecard Results for Billing Optimization C O S T S Increased cash collections by 5% while lowering Average Days Outstanding Value 17
18 18
Patient name; Patient address; Patient Social Security number/medical Record number; Patient date of birth; Patient phone number; Diagnosis code(s);
7 Billing The Sentara Reference Laboratory billing office is open Monday through Friday from 8:00 a.m. until 4:30 p.m. and can be reached by calling (757) 388-1985. Billing Representatives will be available
More informationOptum Intelligent EDI. Achieve higher first-pass payment rates and help your organization get paid quickly and accurately.
Optum Intelligent EDI Achieve higher first-pass payment rates and help your organization get paid quickly and accurately. The new benchmark for EDI performance Health care has outgrown commoditized EDI,
More informationImproved Revenue Cycle Management. Cathrina Caldwell, CPC, CPC-H Director, Sales Product Consulting
Improved Revenue Cycle Management Cathrina Caldwell, CPC, CPC-H Director, Sales Product Consulting Optum Businesses (Formerly Known as Ingenix) One of the largest health information, technology and consulting
More informationMAXIMIZING COLLECTIONS
MAXIMIZING COLLECTIONS Janice Rutter, Director, Support Services, Merge Healthcare Jon Neal, Ph.D., Vice President, InstaMed Mark Snow, Vice President, RevSpring (formerly PSC Info Group) Tracy Sanders,
More informationUnderstanding Coding & Reimbursement for SBI. Presented By: Jen Cohrs CPC, CPMA, CGIC Director of Educational Strategies Wisconsin Medical Society
Understanding Coding & Reimbursement for SBI Presented By: Jen Cohrs CPC, CPMA, CGIC Director of Educational Strategies Wisconsin Medical Society CPT codes, descriptions and material only are Copyright
More informationUsing the Availity Web Portal to build a healthier business
Using the Availity Web Portal to build a healthier business About Availity Agenda Availity and your practice Troubleshooting Enhancements Next Steps About Availity About Availity Availity delivers revenue
More informationAmong the many challenges facing health care
The Value of Visit Management at Your Organization BY ELIZABETH WEIDMAN, SENIOR ANALYST Catch Data Systems April 2014 Among the many challenges facing health care organizations today, few have the potential
More informationImproved revenue cycle management for Epic. Cathrina Caldwell, CPC, CPC-H Director, Sales Product Consulting
Improved revenue cycle management for Epic Cathrina Caldwell, CPC, CPC-H Director, Sales Product Consulting Agenda OptumInsight Overview Traditional physician claim workflow A better way Claims Manager
More informationGlossary of Terms. Account Number/Client Code. Adjudication ANSI. Assignment of Benefits
Account Number/Client Code Adjudication ANSI Assignment of Benefits Billing Provider/Pay-to-Provider Billing Service Business Associate Agreement Clean Claim Clearinghouse CLIA Number (Clinical Laboratory
More informationMolina Healthcare of Ohio, Inc. PO Box 22712 Long Beach, CA 90801
Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your
More informationSection 9. Claims Claim Submission Molina Healthcare PO Box 22815 Long Beach, CA 90801
Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your
More informationThe Availity Health Information Network
The Availity Health Information Network Streamline your workflow Michele Terry 2013 Availity is an independent company providing a wide variety of online tools that allow providers to access real-time
More informationExhausting Other Health Insurance Sources Before Submitting Nursing Home Claims to ForwardHealth
Exhausting Other Health Insurance Sources Before Submitting Nursing Home Claims to ForwardHealth Rose Klaben Third Party Liability Information Systems Business Automation Specialist August 24, 2015 DHS
More informationYour Revenue Cycle It s not just billing anymore. Presented by: Candy Edie, MBA, CRCE-I
Your Revenue Cycle It s not just billing anymore Presented by: Candy Edie, MBA, CRCE-I POSITIONS Staff Accountant Chief Financial Officer Financial Systems Analyst Patient Access Director Patient Financial
More informationREVENUE CYCLE MANAGEMENT (RCM) Bob Strickland Consultant R Strickland & Associates LLC
REVENUE CYCLE MANAGEMENT (RCM) Bob Strickland Consultant R Strickland & Associates LLC REVENUE CYCLE MANAGEMENT WHAT S THE BIG DEAL? Productivity = Efficiency + Effectiveness How much input (cost) is needed
More information3/5/2015. Mike Denison Senior Director of Regulatory Programs Emdeon. Andrea Cassese Director, PTOS Software Patterson Medical
Presented by PTOS and Emdeon March 3, 2015 Andrea Cassese, Director, PTOS Rachael McWhorter, Product Manager, PTOS Mike Denison, Senior Director Regulatory Programs, Emdeon Mike Denison Senior Director
More informationWELLCARE CLAIM PAYMENT POLICIES
WellCare and Harmony Health Plan s claim payment policies are based on publicly distributed guidelines from established industry sources such as the Centers for Medicare and Medicaid Services (CMS), the
More informationRevenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013
Revenue Cycle Kathryn DeVault, RHIA, CCS, CCS-P AHIMA 2013 Objectives Identify responsibilities within the Revenue Cycle Focus on management of the revenue cycle process Discuss the revenue cycle process
More informationPresentation title here
Presentation Provider toolbox title here Sylvia Strickland, MBA, Provider Reimbursement Presentation title here Bridgette Ampey, CPC, Code Review Jorri Smith, Network Innovation & Education priorityhealth.com
More informationERA Manager Implementation. Andrea Frost
ERA Manager Implementation Andrea Frost Agenda Populate ERA Data Utility ERA Manager Demo Setting up a customer for ERA Manager Training your customer on ERA Manager ERA Manager and Task Manager Integration
More informationTennessee Primary Care Association: 2014 Annual Leadership Conference
CPAs & ADVISORS experience momentum // SETTING YOUR ORGANIZATION UP FOR SUCCESS: UNDERSTANDING THE COMPLEXITIES OF THE FQHC REVENUE CYCLE Tennessee Primary Care Association: 2014 Annual Leadership Conference
More informationLeveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance
Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Matt Seefeld CEO & Co-Founder mseefeld@interpointpartners.com www.interpointpartners.com (404)446-0051
More informationEMR Technology Checklist
Patient Accessibility/Scheduling/Account Maintenance: Able to interact with schedule through an online portal pre register VIP status to move patient to the front of the line Access and pre registration
More informationProviders must attach a copy of the payer s EOB with the UnitedHealthcare Community Plan dental claim (2012 ADA form).
UnitedHealthcare Community Plan (formerly APIPA) Medicaid Dental Claims and Billing Process Effective Dates of Service October 01, 2015 or after AHCCCS Provider Identification Number and NPI Number All
More informationThe ROI of IT: Best Billing Practices
The ROI of IT: Best Billing Practices 1 R O S E M A R I E N E L S O N M G M A H E A L T H C A R E C O N S U L T I N G G R O U P The information and materials provided and referred to herein are not intended
More information2011 Provider Workshops. EDI Presents
2011 Provider Workshops EDI Presents 1 Electronic Transaction Exchange The electronic format you exchange with BCBSLA today is referred to as: ANSI 4010A1, HIPAA 4010A1 or 4010 Changes have been made and
More informationManaged Care Organization and Provider Forum Region 3 June 24, 2013
Managed Care Organization and Provider Forum Region 3 June 24, 2013 Humana Headquartered in Kentucky Fortune 100 company Leading national healthcare company 12 million medical members 8 million specialty
More informationInformation Integrity in the Revenue Cycle! Order Entry, All Subsystems and The Charge Description Master
Information Integrity in the Revenue Cycle! Order Entry, All Subsystems and The Charge Description Master 2011 Our Philosophy: We are a firm believer in information integrity. Therefore we perform on or
More informationSolicitation Information November 7, 2012 ADDENDUM # 1 RFP#7458185. Bid Opening Date & Time: 11/15/2012 @ 10:00 AM (Eastern Time)
State of Rhode Island Department of Administration / Division of Purchases One Capitol Hill, Providence, Rhode Island 02908-5855 Tel: (401) 574-8100 Fax: (401) 574-8387 Solicitation Information November
More informationCompensation and Claims Processing
Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance
More informationMedisoft Features Evolution Matrix
1 Medisoft Features Evolution Matrix Insurance Automatic Rebill for Claims Insurance Groupings for Reporting and Analysis Remittance Tracking for Secondary Claims Integrated Electronic Eligibility Checking
More informationHOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE
Billing & Reimbursement Revenue Cycle Management HOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE Billing and Reimbursement for Physician Offices, Ambulatory Surgery Centers and Hospitals
More informationRevenue Cycle Management. A Primer for School Based Health Care Centers Presented By Jane Speyer, Senior Billing Manager OCHIN
Revenue Cycle Management A Primer for School Based Health Care Centers Presented By Jane Speyer, Senior Billing Manager OCHIN Discussion Overview The Revenue Cycle demystified: How do appointments turn
More informationCONNECTIVITY. Connectivity. Solutions. Insight. Electronic Remittance Advice. Technology Eligibility Verification. Challenges Providers Face
CONNECTIVITY. Real-Time Electronic Remittance Advice Technology Eligibility Verification Challenges Providers Face As physician groups face declining reimbursement, escalating operating costs and rising
More informationNH CHIS Annual Meeting. Thursday, July 25, 2013 10:00am 11:30am EDT In-person (NH DHHS Brown Building Auditorium) and WebEx
NH CHIS Annual Meeting Thursday, July 25, 2013 10:00am 11:30am EDT In-person (NH DHHS Brown Building Auditorium) and WebEx Agenda Introductions NH CHIS Team Milliman Team Transition Process Status on NHpreprocessor
More informationDecember 2011 PRACTICE CHECK-UP. XYZ Anesthesia Group. AdvantEDGE Healthcare Solutions www.ahsrcm.com info@ahsrcm.
December 2011 PRACTICE CHECK-UP XYZ Anesthesia Group AdvantEDGE Healthcare Solutions www.ahsrcm.com info@ahsrcm.com (908)-279-8120 AdvantEdge Healthcare Solutions Anesthesia Practice Check-Up I. Introduction:
More informationBILLING HEADACHES? STAFF OVERLOAD! DENIALS LOST REVENUE
BILLING HEADACHES? STAFF OVERLOAD! DENIALS LOST REVENUE END BILLING HEADACHES! - NBI WILL INCREASE YOUR REVENUE. - NBI WILL DECREASE BILLING COSTS. - NBI WILL REDUCE DENIALS. - NBI WILL PROVIDE 100%OFFICE
More informationThe benefits of electronic claims submission improve practice efficiencies
The benefits of electronic claims submission improve practice efficiencies Electronic claims submission vs. manual claims submission An electronic claim is a paperless patient claim form generated by computer
More informationRequirements for HIPAA 5010: Testing & Implementation
Requirements for HIPAA 5010: Testing & Implementation A PUBLICATION OF THE EDI DEPARTMENT OF BLUE CROSS AND BLUE SHIELD OF LOUISIANA 18NW1906 R04/12 Blue Cross and Blue Shield of Louisiana incorporated
More informationEnrollment Guide for Electronic Services
Enrollment Guide for Electronic Services 2014 Kareo, Inc. Rev. 3/11 1 Table of Contents 1. Introduction...1 1.1 An Overview of the Kareo Enrollment Process... 1 2. Services Offered... 2 2.1 Electronic
More informationMEDICAL CLAIMS AND ENCOUNTER PROCESSING
MEDICAL CLAIMS AND ENCOUNTER PROCESSING February, 2014 John Williford Senior Director Health Plan Operations 2 Medical Claims and Encounter Processing Medical claims and encounter processing is part of
More informationHow to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice
How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice Janice Crocker, MSA, RHIA, CCS, CHP Introduction Reimbursement for medical practices has been impacted by various trends and
More informationICD-10 Compliance Date
ICD-10 Implementation Frequently Asked Questions Updated September 2015 ICD-10 Compliance Date The U.S. Department of Health and Human Services (HHS) issued a rule on July 31, 2014 finalizing October 1,
More informationEDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi
EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi 00175CEPEN (04/12) This brochure is a helpful EDI reference for both new and experienced electronic submitters.
More informationEDI Solutions Your guide to getting started -- and ensuring smooth transactions bcbsga.com/edi
EDI Solutions Your guide to getting started -- and ensuring smooth transactions 00175GAPENBGA Rev. 12/11 This brochure is a helpful EDI reference for both new and experienced electronic submitters. It
More informationREVENUE CYCLE CLARITY. Streamlined Solutions for Hospitals and Physicians
REVENUE CYCLE CLARITY Streamlined Solutions for Hospitals and Physicians SOLUTIONS for Hospitals and Large Physician Groups ClaimLogic offers a full suite of advanced claims and payment processing systems
More informationMaximizing Healthcare Payment Automa6on. Arvella Hill, Healthcare Business Analyst
Maximizing Healthcare Payment Automa6on Arvella Hill, Healthcare Business Analyst What Will We Learn? The Four Barriers in Revenue Cycle Management The Claims Process The Payment Challenge The 835 Standard
More informationRevenue Cycle Objectives Challenges Management Goals and Expected Benefits Sample Metrics Opportunities Summary Solution Steps
Common Findings Revealed: Revenue Cycle Review John Bartell, RN, BSN, Partner Tina Nazier, MBA, Director Wipfli LLP Topics for Discussion Revenue Cycle Objectives Challenges Management Goals and Expected
More informationEDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi
EDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi 00175NYPEN Rev. 12/11 This brochure is a helpful EDI reference for both new and experienced electronic
More informationSENDING SECONDARY CLAIMS IN MEDICAL OFFICE MANAGEMENT
SENDING SECONDARY CLAIMS IN MEDICAL OFFICE MANAGEMENT The following are instructions for setting up and sending secondary claims in the Medical Office Management system. As you can see in the next few
More informationStreet Address Apt. or Post Office Box. City State Zip. Telephone Primary: ( ) Home Work Cell. Date of Birth / / Social Security # - -
Appointment Information Date: Time: Physician: Patient Information Name: First MI Last Street Address Apt. or Post Office Box City State Zip Telephone Primary: ( ) Home Work Cell Work: ( ) Cell: ( ) Date
More information2016 HIV Pre-Exposure Prophylaxis (PrEP) Health Insurance Assessment
2016 HIV Pre-Exposure Prophylaxis (PrEP) Health Insurance Assessment December 2015 Report produced by: Cesar Egurrola Clinical Coordinator Petersen Clinics Shannon Smith Director, Special Projects Department
More informationImplementing End-to-End Process Controls To Assure HIPAA 5010 Compliance
Implementing End-to-End Process Controls To Assure HIPAA 5010 Compliance Executive Summary Client: Health Insurance Payer Industry: Healthcare Insurance Challenges: Compliance mandates were costly to achieve
More informationIntelligent EDI Next-Generation Revenue-Cycle Management Capabilities All within the EDI Data Stream
White Paper Intelligent EDI Next-Generation Revenue-Cycle Management Capabilities All within the EDI Data Stream Optum www.optum.com Page 1 White Paper The health care industry s transition to the 5010
More information. NOTE: See Chapter 5 - Medical Management System for conditions that must be met in CHAPTER 6. ELECTRONIC CLAIMS PROCESSING MODULE
Electronic Claims Processing Module 6-1 CHAPTER 6. ELECTRONIC CLAIMS PROCESSING MODULE Processing claims electronically is an option that may be selected in place of or in conjunction with the processing
More informationOutsourcing Revenue Management Can Pay Big Dividends for Clinical Labs
Outsourcing Revenue Management Can Pay Big Dividends for Clinical Labs A report by Donna Beasley, DLM (ASCP) McKesson Revenue Management Solutions, Laboratory Effective management of a clinical laboratory
More informationAdvanced Forms Automation and the Link to Revenue Cycle Management
Advanced Forms Automation and the Link to Revenue Cycle Management Chris Joyce Director of Healthcare Solutions Engineering Today s healthcare providers are facing growing financial pressures that can
More informationAnthem Blue Cross and Blue Shield (Anthem) CLAIMS XTEN TM RULES Version 4.4 Effective December 8, 2012
Rules Edit logic Example Suppted After Hours 99050 not Reimbursable with Preventive Diagnosis This will deny 99050 (services provided when the office is usually closed) when billed with a preventive diagnosis
More informationBasics of the Healthcare Professional s Revenue Cycle
Basics of the Healthcare Professional s Revenue Cycle Payer View of the Claim and Payment Workflow Brenda Fielder, Cigna May 1, 2012 Objective Explain the claim workflow from the initial interaction through
More informationBilling Dashboard Review
Billing Dashboard Review 70 Royal Little Drive Providence, RI 02904 Copyright 2002-2013 Optum. All rights reserved. Updated: 3/13/13 Table of Contents 1 Open Batches...1 1.1 Posting a Batch...1 2 Unbilled
More informationGuide. Health Insurance (Health Service Providers and Insurers) (Claims) Regulations 2012
Guide to Health Insurance (Health Service Providers and Insurers) (Claims) Regulations 0 The Health Insurance (Health Service Providers and Insurers) (Claims) Regulations 0 mandate that the Bermuda Health
More informationReal Time Adjudication
Real Time Adjudication THE HOLY GRAIL or NOT? Market Trends AMA 2009 Cost Survey Report With 2008 Data 9.9% fewer procedures Nunber of patients dropped 11.3% Multi-specialty practices bad debts increased
More informationTrusted Partners for. Revenue Cycle Solutions
Trusted Partners for Revenue Cycle Solutions for over 25 years! 44 Stelton Road Suite 315 Piscataway, NJ 08854 1.800.682.5749 732.752.7052 Fax: 732.424.0084 Revenue Cycle Management Outsourcing Ensuring
More informationOVERVIEW DATA SHEET. MedAct Overview Data Sheet
MedAct Overview Data Sheet MedAct delivers an integrated solution for your HME/DMEPOS that provides end-to-end coverage of all your business needs. From patient intake and purchasing to inventory management,
More informationHearForm & Electronic Billing
HearForm & Electronic Billing HearForm offers a time saving method for transferring CMS 1500 data electronically How does HearForm work with Electronic Billing? HearForm has a robust claims module that
More informationThe CPT Approval Process
The CPT Approval Process CPT is an acronym for Current Procedural Terminology (CPT ). CPT codes are published by the American Medical Association (AMA). A CPT code is a five digit numeric code that describes
More informationContracting and Clean Claims: Billing Techniques for Success!
Contracting and Clean Claims: Billing Techniques for Success! Top 5 Things to Know for CE: Make sure your BADGE IS SCANNED each time you enter a session, to record your attendance. Carry the Evaluation
More informationDelta Dental of Nebraska. Electronic Claims Submission
Delta Dental of Nebraska Electronic Claims Submission Revised 04082009 Table of Contents Introduction... 3 Why Submit Electronically?... 4 Getting Started... 4 Technical Requirements... 5 Submitting Electronic
More informationElectronic Data Interchange (EDI) EDI Claim Confirmation Report
Electronic Data Interchange (EDI) EDI Claim Confirmation Report Recent upgrades to Blue Shield of California s electronic data interchange (EDI) system offer improved reporting to claims trading partners.
More informationSeven revenue-driving best practices
NextGen Revenue Cycle Management Seven revenue-driving best practices 1 2 3 4 5 6 7 Self-pay Collections Measuring Performance Claims Scrubbing Track and Prevent Denials Create and Enforce Write-off Policy
More informationMontgomery County, Maryland Offices of the County Executive Office of Internal Audit
Montgomery County, Maryland Offices of the County Executive Office of Internal Audit United Healthcare Claims Audit August 1, 2014 MCIA 15 3 Highlights Why MCIA Did this Audit Montgomery County Government
More informationGive Your Revenue Cycle a Boost Techniques to Improve Collections for Your Physician Practices
Give Your Revenue Cycle a Boost Techniques to Improve for Your Physician Practices Presented by: Alta Partners, LLC Stan Kasmarcak Susannah Selnick Lacy Sharratt June 8, 2015 2015 Ohio Hospital Association
More informationFrequently Asked Questions About Quality Data Reporting
Why am I being asked to submit claims for all of my patients if SQCN does not have any payer contracts? SQCN is a Clinical Integration (CI) network. The success of our network will depend upon our CI program
More informationInpatient Common Denials
Advanced Billing: Inpatient & Outpatient Services 1 Inpatient Common Denials Introduction Purpose This module will familiarize participants with an overview of the most common denial messages providers
More informationCMS Full Encounter Data by January, 2012
SCAN Health Plan Provider Partners Webinar CMS Full Encounter Data by January, 2012 Presentation: May 25, 2011 CMS Full Encounter Data Agenda Introduction SCAN FED Project Status Updates on CMS Requirements
More informationCODE DESCRIPTION 011 Claim denial (claim level) due to SF message 012 Line denial (line level) due to SF message 017 Incorrect Alpha Prefix 030
CODE DESCRIPTION 011 Claim denial (claim level) due to SF message 012 Line denial (line level) due to SF message 017 Incorrect Alpha Prefix 030 Missing service provider zip code (box 32) 031 Missing pickup
More informationUnpaid Claims Management
Unpaid Claims Management National Association of Community Health Centers (NACHC) 7200 Wisconsin Avenue, Suite 210 Bethesda, MD 20814 301-347-0400 301-347-0459 FAX www.nachc.com AGENDA Introduction Clean
More informationProvider Adjustment, Time limit & Medicare Override Job Aid
Provider Adjustment, Time limit & Medicare Override Job Aid Contents Overview... 1 Medicaid Resolution Inquiry Form... 1 Medicare Overrides... 3 Time Limit Overrides... 3 Adjusting a Claim through the
More informationActivHealthCare EDI User Guide
ActivHealthCare EDI User Guide Table of Contents Page Enrollment 2 Preparing Your Management Software 3 Claims Submission for AHC Network Affiliates 4 Online Entry Tool 7 Claims Follow-Up 8 Frequently
More informationRejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle
Rejection Prevention How Actionable Data Can Drive Results in Your Revenue Cycle Objectives Build a data collection strategy in denials and rejections that drives action and ultimately improved results
More informationChildren s Long Term Support (CLTS) Waiver Third Party Administration (TPA) Claims Processing
Children s Long Term Support (CLTS) Waiver Third Party Administration (TPA) Claims Processing Wisconsin Department of Health Services Division of Long Term Care Bureau of Long-Term Support 1 Third Party
More informationSUBMITTING OTHER PAYER INFORMATION ON PROFESSIONAL CLAIMS VIA THE MITS WEB PORTAL
Submitting Other Payer Information MITS IS LIVE! Release Date: April 15, 2013 SUBMITTING OTHER PAYER INFORMATION ON PROFESSIONAL CLAIMS VIA THE MITS WEB PORTAL Considering Medicaid is the payer of last
More informationManagement Report Services. Staff Training and Education Services
Management Report Services Your management team will receive reports that are clear, well defined and serve as a tool for increased performance. These include a brief description emphasizing how the information
More informationPatient Account Services. Patient Reference & Frequently Asked Questions. Admissions
Patient Account Services Patient Reference & Frequently Asked Questions Admissions Each time you present for a new medical service, a new account number will be assigned. You will be asked to pay any patient
More informationImplementation Tools and Mitigating Financial Impact
ICD-10 Preparation Implementation Tools and Mitigating Financial Impact ICD-10 Preparedness Workshop Series Tuesday, April 2, 2013 John Behn, MPA Getting Started Appoint Steering Committee members Agree
More informationAvaility TM Eligibility and Benefits Inquiry
August 2015 Availity TM Eligibility and Benefits Inquiry An eligibility and benefits inquiry should be completed for every patient at each visit to confirm membership and verify coverage, such as patient
More informationEDI Support Services
EDI Support Services Iowa Medicaid Web Portal The web portal uses the Internet to transport transactions for the Iowa Medicaid line of business only. The web portal provides access to submit and receive
More informationProtect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit
Protect and Improve Profitability in Your Practice Positioning Your Organization for a RAC Audit 2011 Annual Educational Seminar March 9, 2011 Presented By: Cindy Tipton-Cain, Exec. Director Physician
More informationINSURANCE BILLING & COLLECTIONS PROCEDURES
INSURANCE BILLING & COLLECTIONS PROCEDURES I. PURPOSE: To establish logical, consistent methods of billing and collections follow-up for Insurance balances to ensure that all staff members possess a good
More informationDays in Accounts Receivable Days in Accounts Receivable Greater Than 120 Days Adjusted Collection Rate Denial Rate Average Reimbursement Rate
1 Many providers are under the impression they can assess the financial health of their practice by evaluating cash flow only. However, cash flow is just one factor. You don't have to be a finance expert
More informationUniversity of Mississippi Medical Center. Access Management. Patient Access Specialists II
Financial Terminology in Access Management University of Mississippi Medical Center Access Management Patient Access Specialists II As a Patient Access Specialist You are the FIRST STAGE in the Revenue
More informationOFFICE. Clearinghouses: Fact and Fiction. Is Your Ready for October 16? www.infinedi.net. Electronic Claims Submission. Version 2.
Volume 1 September 5, 2003 PrivaPlan Version 2.0 Due Out Soon Is Your Ready for October 16? OFFICE Clearinghouses: Fact and Fiction A letter from our PRESIDENT: Real Time is On-line uick QService Tools
More informationInsurance Terms 101. Patient Access Specialists I
Access Management Insurance Terms 101 University of Mississippi Medical Center Patient Access Specialists I As a Patient Access Specialist Your job is to collect ACCURATE patient information during registration.
More informationManaged Care Trading Partner Testing Packet. Managed Care Trading Partners
Managed Care Trading Partner Testing Packet Information in this ForwardHealth Managed Care Trading Partner Testing Packet is provided to ForwardHealth managed care s who intend to exchange electronic health
More informationElectronic Claims Submission (EDI) Training
Electronic Claims Submission (EDI) Training Part 1 How to completed CMS1500 form Contact Information EDI@ActivHealthCare.com 866-374-9558 770-455-0040 Two parts of Training Part 1: How to complete CMS1500
More informationBlue Cross Blue Shield of Georgia. Frances Phillips Senior Network Relations Consultant And Ron Lawrence Director of Network Management
Blue Cross Blue Shield of Georgia Frances Phillips Senior Network Relations Consultant And Ron Lawrence Director of Network Management Agenda Availity - Frances Functionality Shut-Down November 8 th ICR
More informationSTATE MEDICAID ELECTRONIC HEALTH RECORD INCENTIVE PROGRAM STAGE 1 AND 2 ATTESTATION REFERENCE GUIDE
STATE MEDICAID ELECTRONIC HEALTH RECORD INCENTIVE PROGRAM STAGE 1 AND 2 ATTESTATION REFERENCE GUIDE ELIGIBLE PROFESSIONALS AHCCCS 801 East Jefferson Street Phoenix, Arizona 85034 (602)417-4000 www.azahcccs.gov
More informationREV - Disallowance Procedure
REV - Disallowance Procedure Purpose: conducts disallowance cycles to recover funds from providers where Medicaid paid the provider, but the member has access to Medicare or commercial insurance covering
More informationGoing Green with BCBSNE
Going Green with BCBSNE Health Network Services March 25, 2014 Blue Cross and Blue Shield of Nebraska is an Independent Licensee of the Blue Cross and Blue Shield Association. Agenda Why electronic submission?
More informationRevenue Cycle Management: It Takes a Village. Problem Statement
Revenue Cycle Management: It Takes a Village AHRA 38 th Annual Meeting August 24, 2010 Patricia R. Blank, Executive Vice President, InSight Imaging Nancy Walker, Executive Director, RCM, Insight Imaging
More information