Claims & Remittance

CLAIMS & REMITTANCE [email protected]

Post-ERWUG Notes

For more details – including the slides not covered in Thursday’s session & more – make sure to participate in the UserWeb & Claims’ monthly calls.

If you’re not signed up, contact [email protected] for an invite.

Many of the screenshots in these slides represent changes currently in development & are subject to change. Please do not share this presentation.

Goals

Agenda

Claims

Regulation & Collaboration

Remittance

Discuss Future Directions

Claims Overview

Claim Values Update

Automating Content

Automating Transmission

Reporting

Claim Values & You

Pretty Cool, Right?

Did everyone see the difference? No?

Hint:

<- This Guy?

No. although…the UB Bandit *is* pretty sweet!

Claims Printing

Now This is Happening:

Printer

File Logic derives claim

values after processing

Form printing simply maps CEV items to claim fields

Claims Processing

Nutshell

Discrete record of entire claim

Powerful rules-based configuration

Platform Synchronize electronic & paper image Cancel claims CEV-driven error rules

Vision

Implementation Status

Live since 12/2/12 First run: 99.7% acceptance rate

2012 Model System

Most implementing organizations use CEV

Many groups at various points in converting

At least one live

Getting Started

New UserWeb documentation Now with 86.4%* more screenshots & examples

Work with TS Up-to-date information

Continuing to release content

Feedback?

New Rules

Default Modifier Claim Split Claim Category Charge Modification Filter Claim-Level EOB Type of Bill Condition, Value & Occurrence Codes Claim Complete Filter Claim Edit Filter

Why Rules?

Suppose I only send V04.81 on flu vaccine claims… But I administer vaccines while providing other services!

<- No Problem!

…After 10/1/2014.

D’oh!

<- Problem!

…until:

Now 10/1 will be easy*!

D’oh!

<- Problem!

Voilà:

Why Rules?

[screenshot] Show rule builder power

[screenshot]

• Search for properties throughout system • Also finds existing rules! • “Star” favorite properties

• Compare to values or other properties/rules

With Great Power…

Performance

Delivering the Claims

Delivering the Claims

• Securely transmit electronic claims from Epic

• Send 837 directly to payors or intermediaries

• SFTP, FTPS, HTTPS via Interconnect

Why Transmit?

Timing Today Tomorrow

If you can send, you can re-send

Connectivity limits IT intervention

?

Reconciling the Claims

Reconciliation

[screenshot] ***

Error Reporting

Claim Errors

Dashboard ***

Claim Errors…updateme

[screenshot] [screenshot] [screenshot] ***

Claim Errors

Drilldown ***

Productivity

Claim Edit Productivity

Collaboration Overview

Recent Regulatory Updates

Process

ICD-10

Revised CMS-1500

Condition codes Diagnosis list ICD indicator

Date qualifier Provider qualifier Resubmission code label Other labels, text & removals

Sequestration

[screenshot] Show build document

Ongoing Collaboration

Bulletins

Not-just-HIPAA calls

UserWeb

Opportunities to share best practices Ways to apply & get the most out of the tools

Collaboration – Ideas?

Professional Dual Coding

Cutover Control

Payor preferred codeset

New form-level option Allows carving out scenarios

ICD-10 Updates

UserWeb Forum

Calls & webcasts

Bulletins

Testing updates

Remittance Overview

Cash Reconciliation

Workflow

Reporting

Payments & Deposits & You

Cash Management Workflow

Option 1: Do not use cash records

Option 2: Create new cash records Creates cash records without impacting workflow

Option 3: Use existing cash records

Step-by-Step Cash Matching

EOB/Remittance Money

Cash deposited into bank

Cash records created in Epic, balancing bank

money

Payment/remittance created based on EOB

Payments matched to cash records

Payment filed/posted as transactions

Now can be imported!

Reprocess if cash comes in after Remit

Remittance

[screenshot] [screenshot]

Cash Management

Cash Summary

[screenshot]

Key Questions, Challenges & Lessons

When do you post payments? Do you wait for deposit confirmation?

Do you have access to electronic deposit reports?

Do your check/EFT numbers match the 835? 2014 EFT:ERA Operating Rule

Feedback?

Pop Quiz

Less is More

Schedule gone. Auto-tune, queue priority

Scan gone.

Less is More

Schedule gone. Auto-tune, queue priority

Scan gone.

Less is More

Schedule Auto-tune Background

Scan

Load errors

More is More

Check # Run # Run Name Status Payor Amount Reconciliation # Batch # Procedure Service Area Comment Deposit Date

Location Department NPI Tax ID Load user Process user Load date Process date Check date RMO Filename Cash mode

CSH ID DPR ID Routing number Load errors Cash errors

…all exportable

Reload

Reload & Remove

Why??

[screenshot] [screenshot]

Review

Reporting

[screenshot] [screenshot]

Key Takeaways

Claim values Mid-day claim run Claim reconciliation Remittance reconciliation

Regulation Collaboration

Discuss Future Directions

Focus groups

Attachments & clinical documentation

Expand edit

More real-time tools

Better ways of sharing content

[email protected]