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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Workflow Solutions
Medical Office Workflow:
Speaker: Dave

10. Workflow Solutions
Medical Office Workflow Obstacles:
Speaker: Dave

11. Workflow Solutions
Medical Office Workflow Solutions:
Speaker: Dave

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Workflow
Speaker: Dave

23. 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

24. Question and Answer
Speaker: Both

25. For more information:
Providers – please contact your Practice Insight reseller for more details
Practice Insight Resellers – please contact
Dave Henshaw
(713) ext 7400
Speaker: Dave

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