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Revenue360 for QES version 13 Nick Davis & Jennifer Estes: Tuesday 8/20, 9-10 AM.

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Presentation on theme: "Revenue360 for QES version 13 Nick Davis & Jennifer Estes: Tuesday 8/20, 9-10 AM."— Presentation transcript:

1 Revenue360 for QES version 13 Nick Davis & Jennifer Estes: Tuesday 8/20, 9-10 AM

2 Agenda  Revenue360 for QES Overview & Demo – Revenue360 Platform Overview  Address Validation  Demographic Validation  Insurance Eligibility Verification  Pricing Estimation – Benefits & Results – Q & A

3 3 What’s the most complex job in healthcare?

4 Quote from a Director of Registration for an Ohio hospital It takes me 2 years to train a registrar to learn all they need to know … …but they leave after 6 months! The Challenge…

5 AUTOMATES MANUAL PROCESSES - IMPROVES EFFICIENCY - REDUCES COSTS AND BAD DEBT - INCREASES PRE-SERVICE CASH COLLECTIONS Get it Right the First Time!

6  The right information  To the right person  At the right time  In the right format Computerized guidance ensures your best practice process is followed – preventing many errors that lead to denials and rework Just In Time Knowledge Distribution

7 QES-Revenue360 ® Address Validation

8  Powered by USPS ® Address Matching System & Revenue360 Intelligent Guidance – Integrated directly with QES (auto or manual) – Includes standalone AV option – Web-based, thin client response viewer  Uses facility defined business rules to: – Verify if a Patient / Guarantor address is a valid existing address – Identify unknown or incomplete addresses for Demographic Validation – Update Patient / Guarantor address to USPS standard

9 QES-Revenue360 ® Address Validation Demonstration

10 QES-Revenue360 ® Address Validation

11 QES-Revenue360 ® Demographic Validation

12 Why Validate Identity?  Enhance patient identity management  Improve address input accuracy  Increase Self Pay collections  Decrease accounts sent to collections  Correct known bad addresses  Provide better patient care and outreach  Increase patient satisfaction  Red Flags regulation compliance – fraud detection

13 Red Flags Requirements  The FTC, the federal bank regulatory agencies, and the NCUA have issued regulations (the Red Flags Rules) requiring financial institutions and creditors to develop and implement written identity theft prevention programs, as part of the Fair and Accurate Credit Transactions (FACT) Act of  The programs must provide for the identification, detection, and response to patterns, practices, or specific activities – known as “red flags” – that could indicate identity theft.

14 Types of Red Flags Alerts, notifications, or warnings from a consumer reporting agency; Suspicious documents - drivers license, etc. Suspicious personally identifying information, such as a suspicious address; Unusual use of – or suspicious activity relating to – a covered account; Notices from customers, victims of identity theft, law enforcement authorities, or other businesses about possible identity theft in connection with covered accounts. Red Flags Requirements

15 Revenue360 ® Demographic Validation  Powered by USPS ® AMS, Lexis Nexis ® & Revenue360 Intelligent Guidance – Integrated directly with QES (manual) – Includes standalone DV option – Web-based, thin client response viewer  Uses facility defined business rules to: – Confirm Patient/Guarantor address & demographic information entered into QES – Identify and correct invalid Patient/Guarantor address & demographic information – Locate unknown Patient/Guarantor address & demographic information

16 QES-Revenue360 ® Demographic Validation Demonstration

17 QES-Revenue360 ® Demographic Validation

18  Enhanced Eligibility match – higher clean claims submission  Seamless Integration – no disruption to standard process flow  Increased self-pay collection  Reduced third party collection and write-off expense  Decreased Cost associated with returned mail  Improved compliancy – HIPAA – Red Flags Rule Benefits of Address & Demographic Validation

19 QES-Revenue360 ® Eligibility Verification

20 National Registration Errors Most Common Errors

21 Why Verify Insurance Eligibility?  To get the claim paid – Make sure claim goes out clean – Reduce denials – Increase collections from payer and patient  Identify critical information – Is there benefit coverage for the service – Copy, Deductible & Coinsurance responsibility – Will pre-authorization be required  Goal – Maximize payment for services – Increase cash, lower AR Days, reduce rework & bad debt

22 QES-Revenue360 ® Eligibility Verification Demonstration

23 QES-Revenue360 ® Eligibility Verification The Response Summary simplifies interpreting benefit coverage and discrepancies of what was returned from the insurance company

24 24 Intelligent Guidance – notifies staff that insurance coverage was found for this self-pay patient. Action instructions can be added. Only displays information returned from payer that is different than what you sent in the 270 request Eligibility – Response Summary

25 Full Response is always available for reference now – or later in Billing Office The full 271 response is always just a tab away so that all benefit coverage information is easily accessible Eligibility – Full Response

26 Eligibility – Out of Pocket Expenses Co-insurance, Co-Pay and Deductible Tab simplifies identification and collection of patient out-of-pocket expenses and can easily be exported to the Pricing Estimator

27 27 Eligibility Worklists help manage workflow and find historical transactions Eligibility – Worklists

28 28 Eligibility can be verified anywhere throughout the hospital outside of QES. Patient account set up is not required. Verify benefit coverage for patients that show up in the ED, clinics, physician offices, radiology or anywhere they walk-in to your facilities Eligibility – Standalone Verification

29 QES-Revenue360 ® Pricing Estimation

30  What will their insurance cover?  How much is the procedure?  What is their copay, deductible and coinsurance responsibility?  Can you provide enough information to be credible with the patient?  Is your staff capable of asking for the payment in a consistent patient friendly manner.  What happens if the patient cannot pay? Can you communicate the patients true out-of-pocket cost?

31 Three major components: 1. Charges (Adjudicated Claims) 2. Eligibility and Benefit Coverage 3. Insurance Contracts Total Estimated Amount:$ Estimated Patient Amount: $ Total Allowable Amount:$ Calculate patient total out-of-pocket cost

32 QES-Revenue360 ® Pricing Estimation Demonstration

33 33 When pricing estimate can be provided, “Send to Pricing Estimator” button sends the eligibility response to the Pricing Estimation Module Requesting a Price Estimation

34 Pricing Estimation auto-populates facility and patient information from eligibility module Auto-populates Patient Visit Information

35 CPT Codes can be entered or staff can be guided to the correct code through incremental text search Select Procedure (CPT / ICD) Codes

36 Pricing Estimator auto-populates with the correct service co-pay, co-insurance and deductible from the Eligibility Response Auto-populates Benefit Information from the Eligibility Response

37 Patient total out-of-pocket is instantly calculated and notes can be entered to be added to the payment letter Simplified Accurate Estimates

38 Customized, professional estimate letters can be printed, ed, faxed and include your healthcare system logo – payment remittance options can even be included to assist with front-end collection efforts Customized Letters

39 QES-Revenue360 ® Benefits & Results

40 Guide your staff to make the right decisions for every patient, every time… – Error reduction – prevents common errors – Enforces compliance to your process – Allows staff to focus on patients instead of policies – Improves job performance, satisfaction & retention Getting it right the 1 st time gets the hospital paid faster! – Make sure claims go out clean - reduce denials – Identify patients that need financial help from those who can pay – Maximize collections from both payer and patient – Increase cash, lower AR Days, reduce rework & bad debt Benefits of the Revenue360 Platform

41 BEFORE AFTER Total patient revenue Increased point-of-service revenue Decreased AR Days Actual Customer Results

42 Questions & Answers THANK YOU! For more information go to:

43 Daily Session Evaluation Sheet Giveaway  Don’t forget to complete your Daily Session Evaluation Sheet  Return the completed form to the Registration Desk at the end of each day to become eligible for:  $100 Gift Card daily drawings You are in Session CXX


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