Will Boyd and Lindsay Campbell, BAYADA Home Health Care. Copyright

Transcription

1 Will Boyd and Lindsay Campbell, BAYADA Home Health Care Copyright

2 TODAY S SPEAKERS Will Boyd Director of Home Health Reimbursement Services BAYADA Home Health Lindsay Campbell Manager, Business Analyst Reimbursement Services BAYADA Home Health Copyright

3 AGENDA About BAYADA Home Health Care Our Challenges and Goals Claims Management Gains Denial and Appeal Management Gains Q&A Copyright

4 About BAYADA Home Health Care As a leading provider of home health care services to people of all ages, BAYADA: Provides nursing, rehabilitative, therapeutic, hospice, and assistive care Employs 22,000 caregivers Cares for 25,000+ clients weekly Has 40+ years of experience Operates 300+ offices throughout 22 states and 5 countries Copyright

5 Our Values and The BAYADA Way Compassion. Excellence. Reliability. The BAYADA Way expresses the values and beliefs that have been the foundation of our work since The words of The BAYADA Way come directly from the hearts of our clients and their families, and our employees. - Mark Baiada Copyright

6 Mission Over Money Choosing mission over money, Mark Baiada and his family have gifted BAYADA Home Health Care to a newly created foundation. Build and maintain a lasting legacy as the world s most compassionate and trusted team of home health care professionals. ~ The BAYADA Way Copyright

7 Our Challenges: Where We Started Non-user friendly RCM system High claim denials Electronic claims did not always make it to the payer No tools to trend effectiveness Dependent on manual processes to maintain our AR days Inability to automate, measure outcomes and success rate Copyright

8 Our Goals: Where We Wanted to Go Update RCM systems to newer technology Utilize sophisticated claim edits to increase clean claims and reduce denials Reduce AR days Ensure claims do not get lost Better manage denied claims Automate manual processes across the revenue cycle Transmit claims directly to payers without a middleman Copyright

9 Why We Chose ZirMed Researched RCM solutions for several months Leveraged KLAS reports Tested user interface to ensure it was intuitive and easy to use ZirMed Solutions Selected: o Claims Management o Denial and Appeal Management o Payer Payments o Eligibility Verification Copyright

10 Our Focus for Today Claims Management o Billing claims is so much simpler, transparent and more efficient Denial and Appeal Management o Easily identify denials by payer or denial reason o Easily defined next actions for staff o Made efficiency changes in the process Copyright

11 Claims Management Copyright

12 Claims Management: How We Improved Incorporate Claims Management into our daily follow up Identify the stage the claim is in with the payer Easy access our other ZirMed products Copyright

13 Claims Management EDI Enrollment o Pre-filled out forms o Step-by-step instructions o ZirMed follows-up on the application o If there are complications, ZirMed will reach out to the payer Copyright

14 Claims Management Rejection Insight Rejection Dashboard o Sort rejected claims by reason, payer, agency o Resubmit a batch of rejected claims with one click o Pinpoint trends and correct in your EMR o Monitor rejected claims, name matching and pending enrollment issues Copyright

15 Claims Management Visibility View what stage the claim is in Provides a clear, concise status o Sent to payer o Rejected intermediary/payer o Claim completed o Claim tracking number from payer o Rejection reason o Check number Our team is better prepared for account follow-up Confidence in the system; we know where every claim is in the adjudication process Copyright

16 Claims Management Proof of Timely Filing Detailed information provided by ZirMed when interpreting the 277CA/999 files for Proof of Timely filing Provides all information to appeal for timely filing Actual timestamp of the claim submission process Copyright

17 Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Claims Management Success $12,000 Quarterly Billing Costs $10,000 $8,000 $6,000 $4,000 $2,000 $0 Total Billing Cost Increased clean claim rate by 17%. Decreased costs by 85% We bill 9,000+ claims per month, most electronically, in approximately hours. Copyright

18 Denial & Appeal Management Copyright

19 Denials and Appeals: How We Improved Spotting Trends o Payer processing issues o Carcs and Rarcs allowed us to escalate a trending problem o Workgroups created to gauge volume of problem trends Common Issues Overcome o Volume vs time (efficiency): Identical/similar denials can be mass-appealed o Duplicating efforts: pre-save denial-specific text to send with each denial o Consistency: created a best practice for denials and appeals Customization: Everyone thinks and works differently o Customize workflow setup (by payor, by denial, by amount, etc.) o Important when considering each employee s work style Copyright

20 Decrease in Denial Percentage The denials rate dropped 72%, from 4.6% in January 2017, to 1.3% just six months later. Copyright

21 Actionable Worklists and Workgroups Denial Management takes data from 835s and creates a worklist to focus on actionable denials Denial Workgroups o Customized denial tag separates the denial reason code, payers, tax id..so many options! o Currently we have 31 Denial Workgroups set up After a payer repeatedly denied claims for being out of network, we set up a workgroup and fixed the problem in minutes Copyright

22 Denial Management Workgroups Part B o Missing Modifier Client Elected Hospice - CARC B9 o Credentialing Denials CARC B7 Joint Ventures o Workgroup set up by Tax ID Specific Denial by Payer o Allows us to see trends and provide examples to our provider representative Copyright

23 Increased Productivity for Appeals Payer-specific appeals forms are pre-populated Appeal letter templates Increased productivity for appeals: o More appeals volume to payers o Better understanding of appeals processes, both general and payer-specific o Across-the-board consistency, best practice for appeals The Denial & Appeal Management solution accelerated our process from to less than 5 minutes Copyright

24 Timely Alerts Copyright

25 Additional Success Across the Revenue Cycle We have not had to add staff in three years, despite 50+% volume growth Staff billing time reduced by 85% Staff is more effective and get the support they need ZirMed reps are in constant contact with us and reach out to payers on our behalf Copyright

26 ZirMed End-to-End RCM Solution Built for healthcare. Delivered in the cloud. Claims Management AR Management Charge Integrity Contract Management, Modeling & Payment Variance 24/7, Real-Time Processing True Predictive Analytics Powerful Rules & Edits Engine Eligibility & Coverage Detection Intuitive UI, Workflow DATA AT THE CORE Seamless Integration Patient Responsibility World-Class SaaS Platform Copyright ZirMed. All rights reserved. 26

27 Q&A For more information: Visit Call (855) Copyright