Practice Insight ERA & Denial Manager 2014 Presented By: Deidre Lawson – Product Manager at Practice Insight Dave Henshaw – National Account Manager

Introduction Housekeeping announcements Presenters Deidre Lawson – Product Manager at Practice Insight Dave Henshaw – National Account Manager Speaker: Dave

Agenda TABLE OF CONTENTS Workflow Solutions ERA Manager Demo ERA Manager Implementation ERA Manager and Task Manager Integration ERA Manager Follow up Points to Remember Q&A Speaker: Dave

Did you know: A provider with an average or 6200 claims annually can save upwards of $10,000 a year by using ERA and automating their claims process! Speaker: Dave

Did you know: By Accepting ERA and automating your claims process you can: Speed up payment Save time spent on manual processes such as opening mail, filing and phone calls to payers Eliminate lost EOBs Free time for revenue en Enhancing correct payment Source - AMA Speaker: Dave

Did you know: According to MGMA and the AMA Electronic Remittance totals approx. 70% of total remittances. Therefore, 30% of Remittances still are in paper form Speaker: Dave

Solution: ERA and Denial Manager The ERA and Denial Manager allows providers to organize and manage remittance data Helps staff prioritize and monitor denials and underpayments Allows accurate reporting and viewing of all denials and adjustments Speaker: Dave

Solution: ERA and Denial Manager Providers are able to streamline the denial mgmt process by determining root causes of denials, identify patterns and process breakdowns And establish corrective steps to prevent future revenue loss or delay of payments Speaker: Dave

Workflow Solutions Medical Office Workflow: Speaker: Dave

Workflow Solutions Medical Office Workflow Obstacles: Speaker: Dave

Workflow Solutions Medical Office Workflow Solutions: Speaker: Dave

ERA Manager Demo 4 Parts to train in ERA Manager ERA Manager Manage Tables ERA Manager Main Screen Analysis Reports Task Manager Integration Speaker: Deidre

Major Points of Interest: ERA Manager Demo Major Points of Interest: Manage Tables and Initial Setup Overview of ERA Manager Working ERA Transactions (Task Mgr) ERA Dashboard Reports ERA Web Data Miner Reports ERA Analysis Reports Speaker: Deidre

ERA Manager Implementation Populate provider’s ERA data (vendor action) Manage Tables Match Inbound Payers Assign Group/Reason Codes Label Expected vs Unexpected codes Create Tasks based on settings Look for Claim Adjustment Codes they would want to re-file: Examples: 125: Payment Adjusted due to Billing submission error 16: Claim lacks information needed for adjudication Speaker: Deidre

Task Manager Integration Task Manager Integration allows the customer to easily: Identify Claim Adjustment Group Codes/ Reason codes that ALWAYS need to be followed up on Identify Claim Adjustment Group Codes/ Reason code that require no follow-up $0.00 Paid ERA Transactions ERA Transactions that could not match to a claim Assign work queues based on job responsibility Speaker: Deidre

ERA Follow-Up Action for the Provider Daily: Check tasks and make sure items are being worked Weekly/ Biweekly: Schedule follow-up conversation with reseller Find out what enhancements would make product more effective Find out where remaining pain points are and address them Speaker: Deidre

Points to Remember Main Training Points: Speaker: Deidre ERA Manager provides detailed view of all ERA Transactions in an ERA files. Detailed view includes: charge amount, amount paid, allowed amount, Claim Group and Adjustment codes. ERA Manager provides customers with the ability to sort ERA transactions by CPT code, Check number, Payer, Claims Adjustment Group and Claim Adjustment Reason Code and Status. ERA Manager allows customers to view ERA transactions by status, including Denied ERA Transactions. The Denial Screen allows staff members to add notes while working denials that will be attached to the era transaction. Staff Members can also add a follow-up status to the ERA transaction such as Paid, Appealed, Transfer, etc. Speaker: Deidre

Points to Remember Main Training Points: Speaker: Deidre Analysis reports provide data such as break down of CPT codes that were denied for a Claim Adjustment Group Codes and Reason Code. All ERA data is stored in Manage Tables. The Expects table stores CPT code with modifier, charge amount, allowed amount, and expected paid amount. Customers can use this table to see if they are over/under billing an insurance company and compare allowed amounts. The Codes Table stores all received Group/Reason codes and allows for assignment and prescription of action. The Payer table stores all inbound payer names and allows for matching of unmatched payers. Speaker: Deidre

Points to Remember Tips and Tricks: If claim # equals 0 claim could not be found ERA Manager lists ERA Transactions and there can be multiple transactions per claim The status of the transaction does not change since it reflects the code sent back on the 835. Use Follow-Up Status for status organization All claim follow-up and editing functionality is available in ERA Manager Speaker: Deidre

Points to Remember Helpful Reporting and Follow-up: Analysis by Reason: Lists all Claim Adjustment Reason codes that have been received on ERA files Analysis by Procedure and Reason: Lists all procedure codes that have been denied, and the reason codes that denied them. ERA WebDataMiners (2): Fully customizable reporting tools that allow the user to build their own reports and save them for multi-reporting use Use reporting to analyze denials and take the opportunity to look at what the practice may need: Example: Clinical Claim Scrubbing: Many denials could be avoided by using Clinical Claim Scrubbing on the front-end. Speaker: Deidre

100% Electronic EOB to ERA Additional Solutions ERA & Denial Manager allows the user to analyze the remittances received electronically, but what about paper remits? PI also offers a 100% ELECTRONIC EOB to ERA solution. This solution coupled with lockbox services will ensure 24-hour turn around time for check deposits Paper remits are scanned and imaged and coupled with existing claim data to generate 835 files Most PM systems will automatically post 835 files, eliminating the need for 90% of manual posting! Speaker: Dave

Workflow Speaker: Dave

ERA and Denial Manager Benefits Recap ERA and Denial Manager Benefits Easily identify under and over payments as well as their causes Quickly identify practice status using a dynamic dashboard Reduce future revenue loss or delay Route work automatically to appropriate users Manage line level Denials Speaker: Dave

Question and Answer Speaker: Both

For more information: Providers – please contact your Practice Insight reseller for more details Practice Insight Resellers – please contact Dave Henshaw dhenshaw@practiceinsight.com (713)333-6000 ext 7400 Speaker: Dave

Thank you for your participation!!!!! Speaker: Dave