Effective Billing and Collections. Copyright 2017 State Volunteer Mutual Insurance Company
|
|
- Samuel Booth
- 5 years ago
- Views:
Transcription
1 Effective Billing and Collections 1 Copyright 2017 State Volunteer Mutual Insurance Company
2 Changing Environment Shift in responsibility, payment models and adjustments High deductible health plans (HDHP) Expanded collection effort Transparency 2
3 HSA Qualified High Deductible Health Plan Enrollment March 2005 to January 2016 AHIP, 2017 Census of Health Savings Account High Deductible Health Plans 3
4 Results u Patient s portion can be as large as 30 percent of income u Front desk must attempt to collect this increased portion from the patient u If a patient leaves without paying, the likelihood of collecting decreases by 30 percent 4
5 Revenue Cycle Flow Financial Clearance Patient Check-in & Check-out Charge Capture Coding & Documentation Review Claims Processing Payment & Denial Posting Account Follow-up Denial Management Patient Collections Reporting & KPIs 5
6 Revenue Cycle Reporting Financial Clearance Reporting & KPIs Patient Check-in & Check-out Patient Collections Charge Capture Revenue Cycle Reporting Denial Management Coding & Documentation Review Account Follow-up Payment, Adjustment & Denial Posting Claims Processing 6
7 Financial Clearance u Staff understand financial policy and expectations u Demographic information obtained and insurance coverage and benefits verified u Referrals and authorizations prior to service u Patient payment responsibility Financial Clearance >95% accuracy 92% of consumers reported that it was important to know payment responsibility prior to provider visit InstaMed,
8 Patient Check-in & Check-out Verify and/or update demographic and insurance information Obtain required signatures and/or any additional paperwork Collect and post time of service (TOS) payments and balances Establish credit card on file (CCOF), debit (ACH), or other payment arrangements 8
9 Time of Service Collections InstaMed,
10 Charge Capture Schedule all office visits, surgeries, lab, and diagnostics within scheduling system Generate Unlocked Visits Report or some type of reconciliation Capture hospital, surgical and nursing facility charges Ensure that providers are completing charts timely Charge Lag Days Office 24 hours Non-office hours 10
11 Charge Capture Fee Schedule Individual CPT fees should be priced higher than your highest paying payer Identify Top codes, extract EOBs for each code from a sample of payers Do you know how and at what level fees are priced? 11
12 Coding and Documentation Review Coding responsibilities Audit at least quarterly Update providers and staff Non-specific code use Coding & documentation guidelines Focus of reimbursement 12
13 Risk Adjustment Model u Implemented to more accurately pay Medicare Advantage (MA) plans for treatment of high risk patients u Used by Centers for Medicare & Medicaid Services (CMS) and other payers as a way to estimate future patient costs u Assess individual s health status and demographic details to calculate risk score u Data reported from claims and documentation 13
14 Hierarchical Condition Categories (HCC) Diagnosis codes sorted into groups then into categories Diagnosis categories sorted into condition and given risk adjusted factor Related conditions are assigned to one category - only most serious counted Higher ranked condition causes lower ranked conditions in same category to be ignored (some exceptions) Unrelated conditions in different categories are both counted - score is additive 14
15 Risk Score Example 68-year-old man with pneumonia, emphysema, diabetes with retinopathy, and respiratory failure BCBSAL Complete Picture of Health Documentation and Coding Improvement Initiative 15
16 Claims Processing Review or scrub claims prior to submission Submit claims daily Submission of secondary claims Reconcile claims receipt Track and resolve edits Claim Edits Resolved 0-48 hours 16
17 Payment and Denial Posting Post within 24 hours of receipt Balance! Institute policy for working credit balances 17
18 Adjustments Use of appropriate adjustment types Track adjustments by reason code Review adjustments monthly Use non-contractual adjustments as a training tool 18
19 Account Follow-up Run Open Claims Report at least weekly Organize by Payer, DOS, and dollar amount Utilize insurance collections automation or work queues 19
20 Denial Management Develop process and timelines for working denials accountability Meet appeal guidelines Track denial reasons Identify and fix root cause denials Denial Rate <3-5% 20
21 Patient Collections u Utilize Patient Collections Module or work queues u Become familiar with Fair Debt Collection Practices Act and state laws u Patient statements should be patient friendly u Establish protocols for payment plans InstaMed,
22 Patient Collections Develop a formal process and routinely work Collection accounts should be written off of A/R using a specific adjustment code (or isolate from A/R) Transfer electronically Flag account so all personnel can identify patients in collections Account to Collection Vendor days 22
23 Reporting and Key Performance Indicators (KPIs) Measures the current performance and status of your practice s financial health Helps in identifying practice improvement areas Assists in trending performance over time for comparison Review at least monthly and compare to benchmarks 23
24 KPI Description Frequency Comments Days in AR Calculates the average number of days it Total Current Receivables (net of credits) divided by (Sum of Previous takes to collect payment on services Monthly 12 months gross charges/365) Net Collection Rate Measures revenue cycle efficiency and Collectable Revenue (exclusive of contractual and non-contractual opportunities to improve Monthly adjustments) divided by Net Charges (allowables) % of Patient Schedule Occupied Identifies opportunity to maximize slot Number of Patient Hours Occupied Number of Patient Hours utilization and improve productivity Monthly Available Denial Rate Tracks payer denials and impact on cash flow. Trends payment opportunity and Total number of billed $/units divided by Total number of denied process improvement Monthly $/units Provides opportunity to increase collections, Time of Service Collection % decrease collection costs, and accelerates cash flow Monthly Total TOS Collections Total Amount Collected Bad Debt Ratio Credit Balance as % of AR % of AR >90 days Trending indicator of patient receivables that have been written-off as uncollectable. Measures effectiveness of revenue cycle Tracks accounts that have a negative balance as the result of overpayment or Monthly Total amount of charges written off over a period (annually) divided by total charges overadjustment Monthly Total Credits Total Outstanding AR Trending indicator of receivables reaching an age of difficult collectibility Monthly Sum Aging AR >90 Days New Patient Visits as % of Total Visits Tracks growth of practice Monthly Total Number of New Patients E&M Codes Total E&M Codes 24
25 Report Description Frequency Comments Lag Days Measure charge capture workflow efficiency and identifies delays in cash Monthly Average number of days from date of service to posting date Trending indicator of receivable aging Aged AR distribution and collectibility; shows payment delays Monthly 0-30, >30, >60, >90, >120 days Total Outstanding AR Details frequency of each CPT by Provider; Service Analysis includes total charges for each code (frequency multiplied by charge) Monthly Year End and Year-to-Date by CPT by Provider Summarizes charges, payments and Year-to-Date Activity adjustments for the fiscal year or, preferably for each of the last 12 months, by Provider Monthly Individual month by Provider Payer Mix Aged AR by Insurance Shows charges, payments, adjustments by insurance Trending indicator company of for receivable a specific aging time period Monthly distribution and collectibility by payer; shows payment delays by payer Monthly Year-to-Date and Previous Year by Payer 0-30, >30, >60, >90, >120 days By Payer Group Outstanding AR By Payer Group Report of Open Charts/Tasks Not Billed Tracks Reports unbilled acceptance encounters of electronically filed Daily EDI Report claims Daily Verify all claims accepted and all denials worked Claims On Hold Tracks claims that were submitted to clearinghouse but rejected for various reasons Daily Ensure accountability Unapplied Credits Tracks payments that have not been applied to specific patient accounts/dates of service Monthly Confirm each credit applied to correct DOS No Show/Missed Appointments measures number of times appointments not Total number of no shows divided by total number of patients kept Monthly scheduled 25
26 26
Benchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions
Benchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 502.992.3511 sshover@blueandco.com Revenue
More informationBenchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions
Benchmarking the Revenue Cycle Top 10 Revenue Cycle Best Practice Solutions Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 502.992.3511 sshover@blueandco.com Revenue
More informationEFFECTIVE REVENUE CYCLE MANAGEMENT IN YOUR NETWORK
EFFECTIVE REVENUE CYCLE MANAGEMENT IN YOUR NETWORK 1 INTRODUCTION Revenue Cycle Management has become an even more complex issue with declining reimbursements, implementation of Electronic Health Records,
More informationEthel Owen - Administrator Arthritis & Rheumatology Associates of Palm Beach, Inc. West Palm Beach, FL
Ethel Owen - Administrator Arthritis & Rheumatology Associates of Palm Beach, Inc. West Palm Beach, FL Practice Structure Office Management Physician Encounter Billing Office Physicians & Administrator
More informationSponsored by: Approved instructor
Sponsored by: Approved About the Speaker Nancy M Enos, FACMPE, CPMA CPC-I, CEMC is an independent consultant with the MGMA Health Care Consulting Group. Mrs. Enos has 40 years of experience in the practice
More informationData Definitions for Physician Practice Management (PPM) ONLY
High Performance in Revenue Cycle HFMA MAP Keys Table of Contents: Data Definitions for Physician Practice Management (PPM) ONLY Net Days in Accounts Receivable (A/R) Numerator: Net A/R Denominator: Average
More informationComprehensive Revenue Cycle Management:
Comprehensive Revenue Cycle Management: An Introduction to Our Processes and Protocols 200 Old Country Road, Suite 470 Mineola, NY 11501 Phone: 516-294-4118 Fax: 516-294-9268 www.businessdynamicslimited.com
More informationEffective Revenue Cycles Are No Accident
Effective Revenue Cycles Are No Accident Physician Leadership Institute March 7,2015 Jerrie K. Weith, MBA, FHFMA, CMPE, CMOM Learning Objectives Characteristics of Best Performers Efficient Encounters
More informationTOP 10 METRICS TO MAXIMIZE YOUR PRACTICE S REVENUE
TOP 10 METRICS TO MAXIMIZE YOUR PRACTICE S REVENUE Billing and Reimbursement for Physician Offices, Ambulatory Surgery Billings & Reimbursements Here are the Top Ten Metrics. The detailed explanations
More informationUnlocking and Using Practice Performance Intelligence
Unlocking and Using Practice Performance Intelligence Patti Peets, Director, Revenue Cycle Management CareCloud, Miami Patti Peets does not have a financial conflict to report at this time. 1 Learning
More informationBilling and Collections Knowledge Assessment
Billing and Collections Knowledge Assessment Message to the manager who may use this assessment tool: All or portions of the following questions can be used for interviewing/assessing candidates for open
More informationThe Front-End Revenue Cycle Specialists. The Dilution of the Dollar
The Front-End Revenue Cycle Specialists The Dilution of the Dollar The Silent Revenue Cycle Killer You are likely losing up to 40 cents on every dollar before you even render any patient services. By the
More informationBilling and Collections Knowledge Assessment
Billing and Collections Knowledge Assessment Message to the manager who may use this assessment tool: All or portions of the following questions can be used for interviewing/assessing candidates for open
More informationChapter 7 General Billing Rules
7 General Billing Rules Reviewed/Revised: 10/10/2017, 07/13/2017, 02/01/2017, 02/15/2016, 09/16/2015, 09/18/2014 General Information This chapter contains general information related to Health Choice Arizona
More informationManagement: A Guide To Optimizing. Market
Best Practices In Revenue Cycle Management: A Guide To Optimizing Your Revenue Cycle In A Value-Based Market T h e 2 0 1 8 O P E N M I N D S M a n a g e m e n t B e s t P r a c t i c e s I n s t i t u
More informationAnn Silvia, BS, CPC, CPB, CPC-I, CPMA, CPPM, CANPC, CEMC, CFPC
Ann Silvia, BS, CPC, CPB, CPC-I, CPMA, CPPM, CANPC, CEMC, CFPC This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable
More informationPayment Policy: Clinical Validation of Modifer 25 Reference Number: CC.PP.013 Product Types: ALL
Payment Policy: Clinical Validation of Modifer 25 Reference Number: CC.PP.013 Product Types: ALL Effective Date: 01/01/2013 Last Review Date: 02/24/2018 Coding Implications Revision Log See Important Reminder
More informationMETHOD TO THE MADNESS TODAY S PRESENTER LEARNING OUTCOMES HTH FL Boot Camp. 10 payment collection strategies that work
METHOD TO THE MADNESS METHOD TO THE MADNESS 10 payment collection strategies that work 10 payment collection strategies that work Visit availity.com to download the full e-book TODAY S PRESENTER Colleen
More informationSunflower Health Plan. Regional Provider Workshop
Sunflower Health Plan Regional Provider Workshop Agenda & Objectives e Third Party Liability (TPL) & Coordination of Benefits (COB) Claims Submission Requirements Overview Sunflower TPL & COB Claims Processing
More informationCHAPTER 7: CLAIMS, BILLING, AND REIMBURSEMENT
CHAPTER 7: CLAIMS, BILLING, AND REIMBURSEMENT UNIT 1: HEALTH OPTIONS CLAIMS SUBMISSION AND REIMBURSEMENT IN THIS UNIT TOPIC SEE PAGE General Information 2 Reporting Practitioner Identification Number 2
More information5 STEPS. to Prevent and Manage Denials. kareo.com
5 STEPS to Prevent and Manage Denials kareo.com Table of Contents STEP 1 Calculate Your Denial Rate 04 STEP 2 Identify Top Denial Reasons 05 STEP 3 Implement Eligibility Verification 06 STEP 4 Improve
More informationPCG and Birth to Three Billing Guidance
This information summarizes PCG s and Programs role in accepting data, billing and moving claims towards full adjudication. 1 Workable Claims: Commercial Claims: For Dates of Service from July 1, 2017
More informationKaiser Foundation Health Plan, Inc. CLAIMS SETTLEMENT PRACTICES PROVIDER DISPUTE RESOLUTION MECHANISMS Northern California Region
Kaiser Foundation Health Plan, Inc. CLAIMS SETTLEMENT PRACTICES PROVIDER DISPUTE RESOLUTION MECHANISMS Northern California Region Kaiser Permanente ( KP ) values its relationship with the contracted community
More informationSection 7 Billing Guidelines
Section 7 Billing Guidelines Billing, Reimbursement, and Claims Submission 7-1 Submitting a Claim 7-1 Corrected Claims 7-2 Claim Adjustments/Requests for Review 7-2 Behavioral Health Services Claims 7-3
More informationAppeals, Denials and Audits How to Protect Your Hospital. Shirley Barton, President, AMR Debra Harrison, DNP, RN, AMR
Appeals, Denials and Audits How to Protect Your Hospital Shirley Barton, President, AMR Debra Harrison, DNP, RN, AMR Successfully defending and decreasing denials and appeals through education and persistence
More informationInsurance Transaction Processing. Improve Claim Acceptance and Expedite Reimbursements
Insurance Transaction Processing Connect with thousands of payers from one system VisionWeb s suite of insurance services makes processing claims and managing billing procedures more efficient than ever
More informationHow One Surgery Center Improved Staff Efficiency, Collections and Patient Satisfaction Utilizing Technology
How One Surgery Center Improved Staff Efficiency, Collections and Patient Satisfaction Utilizing Technology Teresa Copeland OrthoTennessee Knoxville Orthopaedic Surgery Center Knoxville Orthopaedic Surgery
More informationZimmer Payer Coverage Approval Process Guide
Zimmer Payer Coverage Approval Process Guide Market Access You ve Got Questions. We ve Got Answers. INSURANCE VERIFICATION PROCESS ELIGIBILITY AND BENEFITS VERIFICATION Understanding and verifying a patient
More informationClaim Reconsideration Requests Reference Guide
Claim Reconsideration Requests Reference Guide This reference tool provides instruction regarding the submission of a Claim Reconsideration Request form and details the supporting information required
More informationLightHouse HEALTHCARE POLICY MANUAL
Page 1 of 7 HIPAA Policy No. 4A Minimum Necessary/Need to Know Policy and Procedure Policy: 4.1 Uses and Disclosures restricted to minimum necessary information Except for uses and disclosures related
More informationRevenue Cycle Internal Audits
Front, middle and back office considerations New England Healthcare Internal Auditors November 30, 2016 Introduction Dave Dreher, Partner Americas Health Internal Audit Leader Andy Adams, Partner Dave
More informationProvider Orientation. style. Click to edit Master subtitle style. December, 2017
Click EMHS to Employee edit Master Health title Plan Provider Orientation Click to edit Master subtitle December, 2017 Pam Hageny Director of Health Plan Operations & Provider Network Beacon Health EMHS
More informationSection 8 Billing Guidelines
Section 8 Billing Guidelines Billing, Reimbursement, and Claims Submission 8-1 Submitting a Claim 8-1 Corrected Claims 8-2 Claim Adjustments/Requests for Review 8-2 Behavioral Health Services Claims 8-3
More informationCMS Provider Payment Dispute Resolution Mechanism
CMS Provider Payment Dispute Resolution Mechanism The Centers for Medicare and Medicaid Services (CMS) established an independent provider payment dispute resolution process for disputes between non-contracted
More informationPlease submit claims and encounters electronically via Office Ally at
Claim Submission All claims must be submitted within 90 calendar days from the date of service for contracted providers unless otherwise stated in the provider service agreement. Please submit claims and
More informationHealthcare Payments. NACHA ECC Meeting January 27, 2010
Healthcare Payments NACHA ECC Meeting January 27, 2010 Presenters June St. John, SVP Wells Fargo Treasury Management Healthcare Product Manager 704-383-2186 june.stjohn@wachovia.com Maureen Turo, VP BNY
More informationFUNDAMENTALS OF BILLING AND CODING
FUNDAMENTALS OF BILLING AND CODING A Basic Training Series for Billing & Coding Staff in the Medical Office ACCMA 2011 About This Manual Copyrighted 2011, The Sage Associates, Pismo Beach, California and
More informationSEQUELMED Glossary. Advance Payment: An amount of money paid by a patient that cannot be applied against a charge at the time the payment was made.
SEQUELMED Glossary Account Number: SequelMed will automatically assign the next unique account number when the user hits the Save button. However, a user can manually assign an account # at the time of
More informationCLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM
CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM The California Department of Managed Health Care has set forth regulations establishing certain claim settlement practices and a process for resolving
More informationRHC Medicare Cost Reporting 101 Katie Jo Raebel, CPA, Partner March 20, 2019
RHC Medicare Cost Reporting 101 Katie Jo Raebel, CPA, Partner March 20, 2019 Wipfli LLP Critical Access Hospital and Rural Health Clinic Conference 0 Today s Agenda Rural Health Clinic Medicare Cost Report
More informationFacility editing: Enhance payment integrity while building strong provider relationships
Facility editing: Enhance payment integrity while building strong provider relationships Optum www.optuminsight.com Page 1 Five steps toward effective facility editing It is a real challenge to edit facility
More informationCRCE Exam Study Manual Update for 2018
CRCE Exam Study Manual Update for 2018 This document reflects updates made to the instructional content from the Certified Revenue Cycle Executive (CRCE-I, CRCE-P) Exam Study Manual - 2017 to the 2018
More informationTen ways Medicare Advantage plans improve risk adjustment success
Ten ways Medicare Advantage plans improve risk adjustment success December 19, 2016 By Sean Creighton Medicare plans need to be on top of their entire risk adjustment game in 2017 and beyond, starting
More informationCommon Reasons for Claim Denials and Ways to Avoid Them
Common Reasons for Claim Denials and Ways to Avoid Them The lifeblood of any thriving medical practice is a steady cash flow. It is, therefore, of upmost importance to recognize trends in payer denials
More information10/10/2017. Course Objectives. Fundamentals of Accounts Receivable. Insurance 102: Accounts Receivable Management
Insurance 102: Accounts Receivable Management Robin Elliott Operations Analyst Stacy Schiltz Operations Analyst Course Objectives Understanding the Fundamentals of Accounts Receivables Utilizing an Insurance
More informationBilling and Payment. To register, call UHC-FAST ( ) or your local Evercare provider representative.
Billing and Payment Billing and Claims On the Web www.unitedhealthcareonline.com Register for UnitedHealthcare Online SM, our free Web site for network physicians and health care professionals. At UnitedHealthcare
More information2019 Merit-based Incentive Payment System (MIPS) Quality Performance Category: Medicare Part B Claims Data Submission Fact Sheet
2019 Merit-based Incentive Payment System (MIPS) Quality Performance Category: Medicare Part B Claims Data Submission Fact Sheet The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the
More informationCEDI: Hosted Claims Manager and Denials IQ 1
CEDI: Hosted Claims Manager and Denials IQ 1 Centricty EDI Services Today s Presenter Claire Wright EDI Business Development Claire Wright joined IDX/GE back in 2005 as an EDI Support Engineer. After
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 informationFidelis Care uses TriZetto's Claims Editing Software to automatically review and edit health care claims submitted by physicians and facilities.
BILLING AND CLAIMS Instructions for Submitting Claims The physician s office should prepare and electronically submit a CMS 1500 claim form. Hospitals should prepare and electronically submit a UB04 claim
More informationSection 7. Claims Procedures
Section 7 Claims Procedures Timely Filing Guidelines 1 Claim Submissions 1 Claims for Referred Services 1 Claims for Authorized Services 2 Filing Electronic Claims 2 Filing Paper Claims 2 Claims Resubmission
More informationPractice Management Advanced Reporting. Presented By: Molly Endress
Practice Management Advanced Reporting Presented By: Molly Endress Session Pin Don t forget to collect your pin as you the leave the session. Clinical Financial Value Based Care Success Patient Engagement
More informationCPC+ PAYMENT METHODOLOGIES: BENEFICIARY ATTRIBUTION, CARE MANAGEMENT FEE, PERFORMANCE-BASED INCENTIVE PAYMENT, AND PAYMENT UNDER THE MEDICARE
CPC+ PAYMENT METHODOLOGIES: BENEFICIARY ATTRIBUTION, CARE MANAGEMENT FEE, PERFORMANCE-BASED INCENTIVE PAYMENT, AND PAYMENT UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE Version 2 February 17, 2017 Table of
More informationCRCS Exam Study Manual Update for 2017
CRCS Exam Study Manual Update for 2017 This document reflects updates made to the instructional content from the Certified Revenue Cycle Specialist (CRCS-I, CRCS-P) Exam Study Manual - 2016 to the 2017
More informationPartnering with Healthcare for Better Revenue Cycle Results HFRI.NET
Partnering with Healthcare for Better Revenue Cycle Results More Paid Claims. More Cash. Our proven combination of expertise and technology delivers results, improving your bottom line and letting you
More information10 Ways to Speed Up Patient Revenue
10 Ways to Speed Up Patient Revenue Deborah Walker Keegan, PhD Medical Practice Dimensions, Inc. 1 Speaker Biography Deborah Walker Keegan, PhD, FACMPE Consultant, Keynote Speaker, Author www.deborahwalkerkeegan@msn.com
More informationAdministrative Guide
Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide 2012 KanCare Program DRAFT PENDING ADDITIONAL UPDATES AND STATE OF KANSAS APPROVAL DRAFT PENDING ADDITIONAL UPDATES
More informationPQRS - The Basics PQRS Physician Quality Reporting System. Presented by: Marcy Le
PQRS - The Basics 2014 PQRS Physician Quality Reporting System Presented by: Marcy Le WHY TALK ABOUT PQRS? WHY DO WE CARE ABOUT THIS? 2014 is the last year that incentive money is available **incentive
More informationLEARNING WHAT IT TAKES TO BILL MANAGED CARE INSURANCES
home health LEARNING WHAT IT TAKES TO BILL MANAGED CARE INSURANCES Lynn Labarta, CEO, Imark Billing 1 home health LYNN LABARTA CEO, Imark Billing Founder of Imark Billing with over 15 years experience
More informationPROVIDER SERVICES Section IV Provider Services
Section IV Provider Services Provider Services 98 NaviNet www.navinet.net Using NaviNet reduces the time spent on paperwork and allows you to focus on more important tasks patient care. NaviNet is a one-stop
More informationFor the RRU Index Ratio, an EXC is displayed if the denominator is <200 for the condition or if the calculated indexed ratio is <0.33 or >3.00.
General Questions What changes were made for HEDIS 2016? RRU specification changes: - We removed the Use of Appropriate Medications for People With Asthma (ASM) measure from the Relative Resource Use for
More informationBuilding Clinical Trial Revenue Integrity Compliance Through Auditing and Understanding Payer Requirements
Building Clinical Trial Revenue Integrity Compliance Through Auditing and Understanding Payer Requirements Kelly Willenberg, DBA, RN, CHRC, CHC, CCRP Kelly Willenberg & Associates Wendy S. Portier, MSN,
More informationTHE FAST AND THE FURIOUS REVENUE CYCLE (A.K.A.) THE REVENUE CYCLE OF THE FUTURE
THE FAST AND THE FURIOUS REVENUE CYCLE - 3.0 (A.K.A.) THE REVENUE CYCLE OF THE FUTURE INDUSTRY ANALYSIS 82% of people say price is the most important factor when making a healthcare purchasing decision*
More informationCoreMMIS bulletin Core benefits Core enhancements Core communications
CoreMMIS bulletin Core benefits Core enhancements Core communications INDIANA HEALTH COVERAGE PROGRAMS BT201667 OCTOBER 20, 2016 CoreMMIS billing guidance: Part I On December 5, 2016, the Indiana Health
More informationHousekeeping. Link Participant ID with Audio. Mute your line UNMUTED. Raise your hand with questions
Housekeeping Link Participant ID with Audio If your Participant ID has not been entered, dial #ParticipantID#. EXAMPLE: Participant ID is 16, then enter #16#. Mute your line UNMUTED MUTED OTHER MUTE OPTIONS
More informationDriving Next-Level Revenue Cycle Performance: 5 Strategies for Physician Practices
Revenue Cycle Management White Paper Driving Next-Level Revenue Cycle Performance: 5 Strategies for Physician Practices Revenue cycle management (RCM) is the lifeblood of any physician practice and one
More informationCentricity Healthcare User Group CHUG
GE Healthcare Centricity Healthcare User Group CHUG Jason Whiteaker, Director Sales Engineering RemitDATA Terri Cipriano, HCM Analyst GE Healthcare Joe Heald, EDI Services Manager, GE Healthcare Imagination
More informationAdjust or not to adjust an entire transaction?
Adjust or not to adjust an entire transaction? Adjustments reduce the ability to collect Adjustments reduce your profit Adjustments can create a loss Consequently, before keying an adjustment, we should
More informationPatient Guide to Billing and Insurance
Patient Guide to Billing and Insurance Patient Account Payment Policies December 2017 Lexington Clinic Central Business Office Payment Policies Customer service...2 Check-in...2 Plan participation, network
More informationCLAIMS Section 6. Provider Service Center. Timely Claim Submission. Clean Claim. Prompt Payment
Provider Service Center Harmony has a dedicated Provider Service Center (PSC) in place with established toll-free numbers. The PSC is composed of regionally aligned teams and dedicated staff designed to
More informationLiving Choices Assisted Living September 2016 HP Fiscal Agent for the Arkansas Division of Medical Services
Living Choices Assisted Living September 2016 HP Fiscal Agent for the Arkansas Division of Medical Services 1 Topics for Today Provider Training Provider Manuals Submitting Claims Claim Adjustments and
More informationClaim Submission. Molina Healthcare of Florida Inc. Marketplace Provider Manual
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 informationPatient Credit and Collections Policy. Penn State Health Revenue Cycle
Patient Credit and Collections Policy Penn State Health Revenue Cycle Effective Date: RC-002 5/11/2017 PURPOSE To provide clear and consistent guidelines for conducting billing, collections, and recovery
More informationDHCFP. Health Safety Net Implementation and Eligibility. A Report by the Executive Office of Health and Human Services
DHCFP Health Safety Net Implementation and Eligibility A Report by the Executive Office of Health and Human Services Division of Health Care Finance and Policy & Office of Medicaid Submitted in compliance
More informationSECTION 9 1 CLAIMS PROCEDURES
SECTION 9 1 CLAIMS PROCEDURES Timely Filing 1 Claims Submission 1 Electronic Claims 1 Paper Claims 1 Claims for Referred Services 2 Claims for Authorized Services 2 Claims Resubmission Policy 2 Refunds
More informationBilling Guidelines Manual for Contracted Professional HMO Claims Submission
Billing Guidelines Manual for Contracted Professional HMO Claims Submission The Centers for Medicare and Medicaid Services (CMS) 1500 claim form is the acceptable standard for paper billing of professional
More informationPRO SPORTS THERAPY, INC. (P.S.T.)
PRO SPORTS THERAPY, INC. (P.S.T.) Dear Patient, Thank you for choosing Pro Sports Therapy. Enclosed is the paperwork we need you to complete and bring to your upcoming physical therapy evaluation appointment.
More informationCMIS. Insurance Specialist (CMIS) Certified Medical CMIS. Understand payer models and rules for accurate claim filing and reimbursement.
CMIS Certified Medical Insurance Specialist (CMIS) CMIS Understand payer models and rules for accurate claim filing and reimbursement. Improving the business of medicine through education This certification
More informationEncounter Data Work Group Summary Notes for Third Party Submitters: Key Findings and Recommendations
Summary Notes for : Key Findings and Recommendations Work Group 2 of 3 This report summarizes the findings of the conducted on. Twenty-one organizations participated in this Work Group and included: Alliance
More informationPayment Policy: Unbundled Professional Services Reference Number: CC.PP.043 Product Types: ALL
Payment Policy: Reference Number: CC.PP.043 Product Types: ALL Effective Date: 01/01/2014 Last Review Date: 03/01/2018 Coding Implications Revision Log See Important Reminder at the end of this policy
More informationP R O V I D E R B U L L E T I N B T J U N E 1,
P R O V I D E R B U L L E T I N B T 2 0 0 5 1 1 J U N E 1, 2 0 0 5 To: All Providers Subject: Overview The purpose of this bulletin is to provide information about system modifications that are effective
More informationCHAPTER 6 REVENUE CYCLE MANAGEMENT
LEARNING OBJECTIVES In this PowerPoint presentation, we will learn about: Revenue Cycle Management in Healthcare Stages in Revenue Cycle Management Healthcare Revenue Cycle Process Revenue Cycle Management
More informationPractical Strategies for Denials Prevention Across the Revenue Cycle
Practical Strategies for Denials Prevention Across the Revenue Cycle For Discussion Purposes Only 2017 nthrive, Inc. All rights reserved. Today s Speakers Gina Stinson Sr. Director, Process Excellence
More informationWinning Under Reform: Strategies to Optimize your Revenue Cycle in 2013
Winning Under Reform: Strategies to Optimize your Revenue Cycle in 2013 HFMA Kentucky Chapter March 15, 2013 PNC Healthcare Advisory Services Today s Presentation Goals 1. Provide some background on U.S.
More informationMedicare Accounts Receivable Management Strategies. Your Speakers
Medicare Accounts Receivable Management Strategies Leading Age Michigan 2014 Annual Leadership Institute Friday, August 15, 2014 8:30 am 9:30 am 1 Your Speakers Janet Potter, CPA, MAS Manager, Healthcare
More informationNational Correct Coding Initiative
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE National Correct Coding Initiative L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 1 0 P U B L I S H E D : D E C E M B E R 1
More informationBest Practices for Optimizing Patient Payment Processes. April York, Novant Health Steve Millhouse, Experian Healthcare
Best Practices for Optimizing Patient Payment Processes April York, Novant Health Steve Millhouse, Experian Healthcare Best Practices for Optimizing Patient Payment Processes Challenges facing the healthcare
More informationAuditing RACphobia. Lamon Willis, CPCO, CPC-I, CPC-H, CPC AHIMA-Approved ICD-10-CM/PCS Trainer Xerox Healthcare Consultant
Auditing RACphobia Lamon Willis, CPCO, CPC-I, CPC-H, CPC AHIMA-Approved ICD-10-CM/PCS Trainer Xerox Healthcare Consultant 1 Agenda Overview of present industry landscape in relation to auditing Audit Entities
More informationCedars-Sinai Medical Group Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM
Cedars-Sinai Medical Group Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM As required by Assembly Bill 1455, the California Department of Managed Health Care has
More informationProvider Dispute Mechanism
This information is intended to inform you of your rights, responsibilities, and related procedures as they relate to claim practices and provider disputes for commercial HMO, POS, and PPO products where
More informationRRU Frequently Asked Questions
RRU Frequently Asked Questions General Questions What changes were made for HEDIS 2015? RRU specification changes: We removed the Cholesterol Management for Patients With Cardiovascular Conditions (CMC)
More informationCPT is a registered trademark of the American Medical Association.
Welcome to s Webinar and Audio Conference Training. We hope that the information contained herein will give you valuable tips that you can use to improve your skills and performance on the job. Each year,
More informationFOCUSING YOUR REVENUE CYCLE
FOCUSING YOUR REVENUE CYCLE GAURAV GUPTA VP, PRODUCT STRATEGY AND PERFORMANCE MANAGEMENT Connect the Data Linkage of previously disparate data promotes root cause analysis & action plan development Integration
More informationCLINICAL RESOURCE GROUP, INC. CHIROPRACTIC ADMINISTRATIVE MANUAL
CLINICAL RESOURCE GROUP, INC. CHIROPRACTIC ADMINISTRATIVE MANUAL UPDATED: 1-1-2012 TABLE OF CONTENTS Chapter One - Provider Services Contact Information Benefit and Summary Verification Communication Resources
More informationCritical Revenue Cycle Success Strategies In An Era Of Integrations
Critical Revenue Cycle Success Strategies In An Era Of Integrations Thursday, February 16, 2012 presented by: Susan E. Ziel, Partner Krieg DeVault P: 317.238.6244 Email: sziel@kdlegal.com Catherine M.
More informationTHE FAST AND THE FURIOUS Revenue Cycle 3.0
THE FAST AND THE FURIOUS Revenue Cycle 3.0 HFMA Arkansas Fall Conference October 19, 2017 Jorge Fernandez, Business Development Principal Availity Hospital Solutions Division HFMA Lone Star Chapter Secretary,
More informationReturn on Investment in Support Staff: Justifying the Value of Financial Counselors and Patient Navigators
Return on Investment in Support Staff: Justifying the Value of Financial Counselors and Patient Navigators Please stand by. The webinar will begin shortly. Return on Investment in Support Staff: Justifying
More informationElectronic Prior Authorization Benchmarking; Dental and Workers Compensation
Electronic Prior Authorization Benchmarking; Dental and Workers Compensation Presented By: Kathy Jönzzon, Delta Dental Sherry Wilson, Jopari Solutions Agenda Overview Prior Authorization Governance Overcoming
More information5 Steps to Reducing Administrative Costs in Physician Group Practices (A05)
5 Steps to Reducing Administrative Costs in Physician Group Practices (A05) Presenters: Kenneth Willman, Director Provider Interface, Humana Melissa Lukowski, Director Outreach, athenahealth Mary Kelley,
More informationWelcome! Ain t Just a River in Egypt! Identifying the Root Cause of Denials and Lost Revenue in Physician Practices.
De-Nile Ain t Just a River in Egypt! Identifying the Root Cause of Denials and Lost Revenue in Physician Practices. Susan Welsh, MHA, CPC, CPC-I, PCS, CHC Welcome! 1 Objectives Identify the most common
More information