Claims & Remittance
Transcript of 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