Front Desk & Back Office: Your Two Keys to Success. Lynne Y Gratton, CPPM PCC 2014 Users' Conference
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1 Front Desk & Back Office: Your Two Keys to Success Lynne Y Gratton, CPPM PCC 2014 Users' Conference
2 Front Desk & Back Office Overview Take Away Front Desk Best Practices Pre Visit Visit Date Post Visit
3 Front Desk & Back Office What is the Take Away? Learning the importance of the front desk and back office working together to collect money. Tools to help
4 Front Desk Best Practices Customer service Telephones Keep them busy Goals for the front desk Oversight
5 Front Desk Best Practices Customer Service First impressions count Get rid of the glass Greet patients immediately Work as a team, help each other with overflow Separate sick and well waiting rooms
6 Front Desk Best Practices Customer Service Wait for a response before putting someone on hold Discuss significant billing issues in private Have at least one billing staff with an office near the front Do not discuss other parents/patients at the front desk
7 Front Desk Best Practices Phones Move phone triage away from the front desk Allow front desk staff to focus on verifying demographics, insurance, collecting payments Use phone system to appropriately route calls
8 Front Desk Best Practices Keep Them Busy There should be no down time at the front desk If things slow down, have them work on recall lists Call patients overdue for well visits, Asthma checkups, ADHD checkups, flu shots, etc.
9 Front Desk Best Practices Goals Goals of the front desk: Great customer service Generate clean claims from a demographics stand point Increase time of service payments Reduce the amount of collections after the visit
10 Front Desk Best Practices Oversight Track how much recall they are doing Track copay collection rates Track collections for past due balances Set goals and reward staff for achievements
11 Pre-Visit The processes used prior to when a patient comes in will impact the quality of your claims, increase TOS payments, and help reduce the amount of collections needed. In short the Front End functions drive the revenue cycle.
12 Pre-Visit Scheduling Appointment Verification Eligibility Verification Eligibility Using Partner Billing Department Prep
13 Pre-Visit: Scheduling Verify Verify demographics! demographics! Copay & Balance reminder Verify insurance! Update demographics easily with F6
14 Pre-Visit: Scheduling New Patient Process Who collects insurance information over the phone? F4/F7 can be configured to bring you directly to eligibility and the policy program Remind them to bring their insurance card and copay
15 Pre-Visit: Scheduling Points to make during appointment verification Verify date, time, and visit reason Verify insurance plan, subscriber, start date, and end date Remind patient to bring in their insurance card payment for expected copay & outstanding balances
16 Pre-Visit: Appointment Verification Appointment Verification Why? When? How?
17 Pre-Visit: Appointment Verification What to verify during reminder calls Date, time and visit reason Insurance plan, subscriber, start/end dates Reminders
18 Pre-Visit: Eligibility Verification Eligibility Verification Why? When? How?
19 Pre-Visit: Eligibility Verification Partner's elig program Auto eligibility overnight Update policy information as needed through elig, especially copays! Use notes for the front desk to see at checkin Eligibility for visits more than two days away?
20 Pre-Visit: Billing Dept Prep Develop a financial policy you share with parents. Develop guides to educate patients about insurance responsibility. Understand basic information about patient insurance plans and share with the front desk.
21 Same Day Visits Scheduling Verification Reminders Eligibility Real time with elig if possible Check online/via phone as needed
22 Day of Visit Patient Check In (checkin) Posting Charges (checkout) Clean claims
23 Day of Visit: checkin Why use checkin? Most Common Clearinghouse Claim Rejection Reasons can be avoided by properly using the checkin program TOS payments
24 Day of Visit: checkin Demographics Update demographics
25 Day of Visit: checkin Demographics Meaningful Use anyone?
26 Day of Visit: checkin Eligibility Are there notes to review? Verify eligibility has already been checked On demand eligibility check
27 Day of Visit: checkin Eligibility Make sure eligibility has been verified Relationship code for child or self Online eligibility systems do not ask for patient relationship to subscriber. Real time eligibility requires this be correct or the insurance will not return a response.
28 Day of Visit: checkin Policies Is policy information accurate and up to date?
29 Day of Visit: checkin Policies Always get a copy of their insurance card Verify subscriber information
30 Day of Visit: checkin Copays Expected copay Copay notes and primary policy Previous personal balance or credit
31 Day of Visit: checkin Copays Questions about a past due balance? Use F4 to Show Details
32 Day of Visit: checkin Copays Make sure to collect the proper copay amount, sick vs. well HSA Accounts Credits appear as a instead of a CR as part of the balance
33 Day of Visit: checkin Copays Store and process credit card payments online Get authorization from the family to charge their credit card for outstanding balances Flag their account Use a secure web service PaySimple (paysimple.com) PayPal
34 Day of Visit: checkout Schedule next appointment Missed appointments Proper insurance configuration checkout screens pre-set by visit reason SNAP codes Clean claims Account for all visits
35 Day of Visit: checkout Schedule next appointment Make sure your schedule is out at least 6 months so you can schedule younger children easily, 1 year is better!
36 Day of Visit: checkout Track missed appointments Charge for missed appointments and make sure that is part of your financial policy When you post a missed appointment fee in Partner, make sure it is configured to automatically mark the appointment missed in Patient Inquire (inquire)
37 Day of Visit: checkout Insurance Config Proper insurance configuration Pending correct procedures Submitting correct procedures Different copays for well vs. sick codes Support can help you fix any of these not working properly.
38 Day of Visit: checkout Screens checkout screens Setup using Charge Screen Editor (csedit) Can vary by visit reason, place of service, and/or provider
39 Day of Visit: checkout SNAP codes SNAP Code Table Use for so procedures are not missed, ie. Immunizations Each SNAP code can link up to 21 procedures, each capable of linking to 4 diagnoses codes each! Can be placed on screens using the Charge Screen Editor (csedit)
40 Day of Visit: checkout Clean Claims Verifying quality claims Daysheet Postings Check (dailycheck) Changing insurance after charges are posted Pre-authorization / Referral requirements
41 Day of Visit: checkout Clean Claims Always link diagnoses to procedures Certified coder on staff Train staff on basic coding scenarios Use SNAP codes to reduce missed procedures
42 Post Visit Insurance Collections Personal Collections
43 Post Visit: Insurance Collections Claims submission Posting payments / responses Claims follow up Claim submission tools and reports
44 Post Visit: Claim Submission
45 Post Visit: Claims Submission preptags Bad Claims Report Sample preptags Bad Claim Report Error Date: 07/16/12 PCC #: Patient: Bart Simpson Guar PCC#: Cus PCC#: Claim is for an insurance company no longer on the patient Charge filed with: UNITED HEALTHCARE BOX $20
46 Post Visit: Claim Submission Partner Claim Responses ECS Batch Logs Clearinghouse/Intermediary Responses Delivered via clearinghouse or gateway Rejected claims are not submitted to payers Accepted claims are submitted to payers
47 Post Visit: Claim Submission Finding Electronic Claim Responses in Partner Correct Mistakes (oops) EDI Reports (ecsreports)
48 Post Visit: Follow Up Claim Submission Tools Electronic Claim Responses in Correct Mistakes (oops) Use the <F4> Insurance Status function key to access the claim responses (e.g. lines 4, 5, and 6)
49 Post Visit: Claim Submission EDI Reports (ecsreports)
50 Post Visit: Claim Submission To learn more about EDI reports attend Justin and Phil's Read and Understand Your EDI Reports class on Thursday at 10:45am!
51 Post Visit: Payment Posting Autoposting of payments ERA vs EFT autopip RARC and CARC erareports
52 Post Visit: Payment Posting autopip What's ERA? What's EFT?
53 Post Visit: Payment Posting autopip ERA is not EFT Most payers allow receipt of either or both Some payers require both Partner doesn't facilitate processing of EFT
54 Post Visit: Payment Posting autopip Sample ERA
55 Post Visit: Payment Posting autopip How does ERA benefit you? Standardization of presentation format/layout ERA is generally delivered more quickly than a paper/mailed EOB ERA is required for automatic payment posting
56 Post Visit: Payment Posting autopip autopip is Partner's automatic insurance payment posting program Why are you not using this program? autopip works in conjunction with pip Yes, you'll still need to post some payments the old fashioned way
57 Post Visit: Payment Posting autopip Learning to use autopip autopip and the autoposting process is documented at Our video tutorial is highly recommended!
58 Post Visit: Payment Posting autopip Unposted ERA payments are presented by payment date, payor, check number, and check amount
59 Post Visit: Payment Posting autopip
60 Post Visit: Payment Posting autopip Partner autoposting in a nutshell autopip posts the claim payments it can Claim payments which are not autoposted are directed to the Manual Post Report Print the Manual Post Report and post those payments with pip, i.e. the old fashioned way
61 Post Visit: Payment Posting autopip Use a different default payment/adjustment type than pip to make auto postings easier to see in Partner programs Payment Types table ced option
62 Post Visit: Payment Posting autopip Which payments and adjustments must be manually posted? Those for which the charge amount, CPT, and/or copay doesn't match Partner's data Those which don't relate directly to charges with unpaid insurance balances Denials
63 Post Visit: Payment Posting autopip Which payments and adjustments must be manually posted? Depending on your Partner configuration Adjustment codes which are not predefined as acceptable for autoposting Payments which do not match the corresponding Partner allowable value
64 Post Visit: Payment Posting autopip Remittance Advice Remark Code (RARC) and Claims Adjustment Reason Code (CARC) Values HIPAA standardized the coding payers use to identify adjustment reasons All payers must use the standard code values in electronic remittance advice Partner's formatted ERA translates the codes to the corresponding text descriptions
65 Post Visit: Payment Posting autopip Remittance Advice Remark Code (RARC) and Claims Adjustment Reason Code (CARC) Values RARC Values CARC Values
66 Post Visit: Payment Posting autopip erareports erareports provides access to archived ERA data separated by check, like autopip All ERA autoposted, manually posted, and unposted is presented, separated by payment date, payor, check number, and check amount Search and print functions are provided
67 Post Visit: Payment Posting autopip How do I get started with autoposting? 1.Register to receive ERA from Partner's supported payers at 2.PCC's EDI Support Team will respond and assist with ERA payor registration as applicable 3.Preview the online documentation for Partner ERA and autoposting
68 Post Visit: Payment Posting erareports
69 Post Visit: Payment Posting pip Posting insurance payments manually, aka pip Payment/Adjustment types to track denials CARC fields can be configured to appear Insurance Allowables / Fee Schedules
70 Post Visit: Payment Posting pip Allowable values, schedule and config option CARC Values
71 Post Visit: Follow Up Unpaid claims Denial management Appeals process Partner claims submission tools and reports
72 Post Visit: Corrections oops and oopsp Correct insurance <F4> Correct diagnoses <F5> Correct billing provider <F5> Batch corrected claims <F2> Unlink/Relink payments <F6>
73 Post Visit: Follow Up Partner Tools maketags insaging inscoar interactive mode srs Billing & Collection reports ecsreports allowedit cfs
74 Post Visit: F/U Partner Tools maketags ONLY for special circumstances
75 Post Visit: F/U Partner Tools insaging Use to find insurance companies not paying timely
76 Post Visit: F/U Partner Tools inscoar inscoar generates a list of outstanding claims Interactive gives you access to everything! fame (notes) notjane refund pam pip oops checkout
77 Post Visit: F/U Partner Tools inscoar
78 Post Visit: F/U Partner Tools srs Billing & Collections Gross Collection Ratio Report
79 Post Visit: F/U Partner Tools srs Billing & Collections Claim Error Report
80 Post Visit: Follow Up Partner Tools Allowables allowedit srs Allowable Overpayments Report Allowable Underpayments Report Attend the Tracking Allowables course today at 3pm to see how to setup your allowable / fee schedules and let Partner track under and over payments for you automatically!
81 Post Visit: F/U Partner Tools cfs Check accounts with specific flags used for follow up your office may have created
82 Post Visit: Follow Up Challenges Unpaid claims Denial management Appeals process Partner claims submission tools and reports
83 Post Visit: F/U Challenges: Variety of plans covering your families Coding requirements Ever-changing payer 'rules' Claims submission address changes
84 Post Visit: F/U Division of work load By carrier By task Claims submission Payment posting Follow up on denials Follow up on unpaid claims
85 Post Visit: F/U Unpaid Claims Follow up schedule for contacting the carrier Call if no acknowledgment of receipt of claims 10 days for paper 3 days for electronic inscoar srs
86 Post Visit: F/U Denial Management Create denial/appeals procedure Automate appeal form letters Reminder system for followup tickle Account flags
87 Post Visit: F/U Appeals Know you payer contacts Claims services representative Provider services representative Claims supervisor Appeals coordinator Medical review manager Medical Director
88 Post Visit: F/U Appeals Sample phone call with carrier Have necessary data in front of you inscoar: interactive mode Know the history of the claim Ask for a time estimate for response
89 Post Visit: F/U Appeals Sample phone call with carrier Make detailed notes in the Family Editor (fame) Track start/end time Names, titles, phone number and extension Check numbers and dates Claim id numbers Reference numbers
90 Post Visit: Personal Collections Send personal bills Post payments Work Personal A/R Sending an Account to Collections Reports
91 Post Visit: bills/ebills Personal bills ebills vs bills Cycle billing Billing messages Finding bills sent in the past
92 Post Visit: bills/ebills ebills vs bills Look more professional Plain printing, nothing fancy Submit electronically Print in your office Cost per bill $ first page $.2235 each addt'l page Folding, stuffing, stamping, and time costs More control
93 Billing message Account Billing Notes Post Visit: bills Budget / Payment Plans on Bills and in fame
94 Post Visit: ebills/relayhealth Budget Budget amount amount appears here appears hereifif set in in fame. set fame. Account billing notes and billing messages appear below the aging section.
95 Post Visit: Cycle Billing Sending out bills weekly instead of monthly Personal payments come in all month Manual cycles Breaking up bills
96 Post Visit: Cycle Billing Partner Cycle Billing Set your cycle to 28 days Run bills weekly When does an account get a bill?
97 Post Visit: Billing Billing Messages Available in ebills and bills By billing aging category
98 Post Visit: Posting Personal Pmts ALWAYS link personal payments to specific charges!
99 Post Visit: Billing Account Billing Notes Available in the Family Editor (fame) Use cfs to track which accounts have account billing notes
100 Post Visit: Billing billlog Researching previously sent bills billlog aka F8 in bills/ebills
101 Post Visit: Billing billlog
102 Post Visit: Billing billlog Accounts Billed See who received a bill Includes the bill amount View the actual bill sent using F1
103 Post Visit: Billing billlog Accounts Not Billed See who did not receive a bill Includes why they did not receive one
104 Post Visit: Billing billlog Accounts Not Billed See who did not receive a bill Includes why they did not receive one
105 Post Visit: persview Use your bills cut off balance. Focus on one aged account at a time. You may wish to exclude/include by account flag.
106 Post Visit: persview Many function keys to help you review each account from one program. Work With All lets you run commands for each account
107 Post Visit: persview Use form letters to automatically add flags to each account on the list, as well as print a letter. Print a bill for every account on the list.
108 Post Visit: Payment Plans Setting up a payment plan Create a form letter explaining their responsibilities Update the Budget field in fame Give them a flag so you can easily review the accounts on a payment plan to verify they are paying
109 Post Visit: Payment Plans Add the Budget Amt amount inbudget fame and it appears here if appears on personal fame. bills as set thein due field.
110 Post Visit: Payment Plans Last payment date includes copays! Print missed payment plan form letter easily. Access coll via fame Jump into to see pmts. oops as needed.
111 Post Visit: notify Notify allows you to send account balance information. Hello this is Pediatric Associates calling. Our records indicate that your account is more than 60 days overdue. Please call our office at to arrange payment today. Thank you!
112 Post Visit: Collections Sending an account to collection agency, two options Adjust off charges Pend charges to Agency Regardless of option selected above: Print charge information for collection agency
113 Post Visit: Collections - Adjust Charges Run Post Personal Payments (pam) Find account Post Bad Debt/Collection Adjustment and link to charges being sent to collections Add Collection flag to account Update account notes
114 Post Visit: Collections - Adjust Charges Post the adjustment Link the adj to the charges Add Collection flag and notes to the account
115 Post Visit: Collections - Adjust Charges When you receive a payment from the collection agency do one of the following two options, then add a note in fame. Delete the bad debt adjustment you posted and post the payment using a payment type that indicates the payment was from a collection agency. Post a "Collection Income" adjustment in the refund program and then post a Collection Payment against that adjustment using pam.
116 Post Visit: Collections - Pend Agency Partner configuration needed for this option Add Collection as an insurance group Adding 1. Collection Agency as an insurance company This makes it easier to find in oops
117 Post Visit: Collections - Pend Agency Partner configuration needed for this option Add Collection as an insurance group Adding 1. Collection Agency as an insurance company Go into Correct Mistakes (oops) for this account and change the charges to pend the 1. Collection Agency Add Collection flag and notes to the account
118 Post Visit: Collections - Pend Agency Find the charges Hit F4 to pend to the new collection agency insco
119 Personal Collections Post Visit Collections: Adjust Charges Type in the numbers for the charges going to collection
120 Post Visit: Collections - Pend Charges Some Other Insurance allows you to choose any insurance company The 1. sorts the Collection Agency to the top of the list
121 Post Visit: Collections - Pend Charges Now hit F1 to save and the charges will be pending collection
122 Post Visit: Collections - Pend Charges Use insaging and inscoar to review charges pending the 1. Collection insurance company. Post payments using pip Leave balance pending 1. Collection or adjust off Update notes on the account in fame Post a follow up to the original note
123 Post Visit: Other Reports Smart Report Suite (srs) Billing & Collections Reports Accounts with Credit Balances Collection Worksheet for Appointments Copay Collection Ratio Insurance Eligibility Report Insurance Eligibility Report for Same Day Appts
124 Front Desk & Back Office: Review Pre Visit Scheduling Appointment Verification Eligibility Verification Billing Department Prep
125 Front Desk & Back Office: Review Visit Date Patient Check In (checkin) Posting Charges (checkout) Clean claims
126 Front Desk & Back Office: Review Post Visit Insurance Claims submission Posting payments / responses Claims follow up Claim submission tools and reports
127 Front Desk & Back Office: Review Post Visit Personal Send personal bills Post payments Work Personal A/R Sending an Account to Collections Reports
128 Front Desk & Back Office Questions? At 3pm this afternoon head to the Collection Roundtable for more discussion.
129 Front Desk & Back Office learn.pcc.com Click on Partner Click on Insurance Billing cebilling/insurancebillingintro.htm Click on Personal Billing albilling/personalbillingintro.htm
130 Post Visit: Follow Up Unpaid claims Denial management Appeals process Partner claims submission tools and reports
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