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Today’s Revenue Cycle Process: Helping You Sleep Better at Night Presentation to N.W. Ohio HFMA August 29, 2012 Jim McCauley, Vice President, EDI Services.

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Presentation on theme: "Today’s Revenue Cycle Process: Helping You Sleep Better at Night Presentation to N.W. Ohio HFMA August 29, 2012 Jim McCauley, Vice President, EDI Services."— Presentation transcript:

1 Today’s Revenue Cycle Process: Helping You Sleep Better at Night Presentation to N.W. Ohio HFMA August 29, 2012 Jim McCauley, Vice President, EDI Services Increase Cash Flow….Drive Revenue Cycle Efficiencies….Reduce Bad Debt ….

2 Xpeditor Xtensions Do More!....

3 Xpeditor Xtensions....

4 Claims Management X

5 Powerful edit engine –Standard: LCD, NCD, CCI, OCE, MUE, RAC edits –Custom (client defined): written by Quadax developers, usually 48-hour turnaround (testing may require additional time) –Client-written: developed through the XpressBiller utility, an easy-to-use wizard.. Better cash flow! Faster reimburse- ment Cleaner claims....

6 Claims Management X Comprehensive reporting enables you to manage your claims, not just transmit them Every edit available for analysis Eliminate manual intervention & compilation of data....

7 Remittance Management X

8 Remittance Management.. Full Integration Full Support Management Tools Better Data (including posting files & comment records)....

9 Denial Management X

10 Effective denial management strategy –Identify, Classify, Quantify –Manage Denial Follow-Up –Prevent Denials Through Process Improvement –Develop Effective Reporting Scheduling Service Providing Service Coding Service Billing Service Collecting Payment Where do denials come from? Any and all points in the revenue cycle......

11 DM X BR : Basic Reporting.... Anything that is delaying payment to your organization is ripe with data for process improvement. Payer Remits 835 Files Hard Copy Remits Denial Correspondence Payer Rejections 277 Files864 Files Payer Reject Reports Pre-Bill Errors Quadax Batch Errors Customer- defined Errors XpressBiller Errors Approximately 2,100 codes Approximately 13,000 codes Approximately 250 ANSI codes Pre-mapped to standard error/denial categories..

12 DM X WF: Workflow Decrease Overall A/R –Quickly identify both full and partial denials and route them to users with best skill sets to work them –Provide easy access to key denial source documents for follow-up users Decrease Costs to Work Denials –Improve staff efficiency in working denials by setting up default orders within worklists to group similar types denials Increase Visibility of Denial Aging Inventory –Utilize management dashboard reporting to target key denial inventory issues......

13 DM X : A Case Study Note: Payments reflect Charges associated with Paid Claims (not actual payments); Denials Reflect Charges associated with Denied Claims/Lines. Claim Status 22 has been excluded and denials with prior payment have been excluded. Duplicate Example (18/B13/97). FYI – 96 has been included under non-covered service.....

14 Eligibility X

15 Verify that an individual has valid Insurance coverage Validate demographic information to match spelling, etc. on file with payer Determine the level of coverage for service type Determine Co-Pay, Deductible, other Insurance, etc. Tip: Do a batch eligibility check on self-pay to ensure patient was not eligible for Medicaid on date of service

16 Eligibility X –Real Time (any point of entrance) –Automated (specified claims, self-pay, Medicaid) –Batch (pre-registration, self-pay, collection accounts) –Back End (rejected, denied)....

17 Eligibility X HIS Interface Eligibility Individual or “Batch” (multiple transactions), in real time 270 from HIS 271 returned to HIS Outside Xpeditor We have developed the interface for Epic, Meditech, and SMS Allegra (TCP/IP). Development of additional HIS interfaces is expected. Batch File Eligibility Batch File Delimited file according to agreed-upon specs Outside Xpeditor Standalone Eligibility – Hosted, for those offices not on the hospital network Individual, in real time Manual entry using form on Portal Xpeditor-style response form Outside Xpeditor (Separate hosted install accessing only Real-Time screens) Transactions stored in Real-Time transaction History Database Real-Time Eligibility Individual, in real time Scrape from claim or manual entry using form in Xpeditor Xpeditor-style response form History stored in Xpeditor; linked to claim if inquiry scraped from a claim Rule-Based Eligibility AutomatedGenerated from Xpeditor; Rule- Based (custom convert required) Xpeditor-style response form History stored in Xpeditor; linked to related claims For example, a rule might dictate that all self-pay claims automatically generate an eligibility inquiry to Medicaid.....

18 Claim Status X

19 There are always exceptions –Do you know what they are? –Do you know why they are? Claim Status X Is there a need for an automated solution to help manage and report on these claim delays?......

20 Claim Status X HIPAA-mandated 276/277 still coming into its own Perform transactions manually, as needed Automated Claim Status responses can be exported to the host system. Either source 277 can be provided or a customized comment file

21 Automated Claim Status Transactions Eliminate the need for sifting through reports Eliminate wasted time on the phone with payers Eliminate keying into payer web sites Rely on automated processes to catch every outstanding (unpaid) claim Be assured that no claims have fallen through the cracks Improve efficiency & Days in A/R with faster intervention......

22 Audit Control X

23 Full suite of products to manage every kind of audit: RAC, MIC, etc. Preventive Edits Audit Control X Axis DataXtract Data Mining Also available from our partners, Human Arc and EHR: hands-on appeals management Audit Control X....

24 Audit Control X Axis A Secure, web-based, hosted application –Gives everyone on your RAC team easy access Axis™ for workflow, tracking, & reporting Integration with –AHA RACTrac –Human Arc –EHR....

25 Medicare Connection X

26 Interactivity with FISS for enhanced Medicare claims control Faster Reimbursement Streamlined Workflow Better Reporting Medicare Connection X....

27 Questions......


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