HealthCo: Centricity Clearinghouse Overview
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Centricity Clearinghouse Overview Presented by: Jason Porter, HealthCo Information Systems
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Transcript of HealthCo: Centricity Clearinghouse Overview
Centricity Clearinghouse
Overview
Presented by:
Jason Porter, HealthCo Information Systems
Today’s Presenter
Jason PorterVice PresidentHealthCo Information Systems
• National Partner for GE Healthcare
• Support thousands of physicians in their use of the Centricity EMR/PM platform
• Founded in 1997
• Located in Portland, OR
• Mission to improve patient care and financial performance of independent physician practices
Centricty EDI Services
Product Overview: Hosted Claim Manager
Product Overview: Denials IQ
Powerful algorithm analyzes claims data weekly to provide dashboards that reveal denial trends by code, payor, physician, location and a number of other categories, allowing the clinic to rework denials in bulk and set rules via HCM to prevent these denials in the future.
Agenda
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• Welcome
• Centricity EDI Services Overview
• Hosted Claims Manager and DenialsIQ™
• What is Next?
• Summary
Introduction to Centricity EDI
Services
Switching Clearinghouse’s Is a PAIN…Right?
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Situation: Using non-integrated CH and experiencing reduced cash flow, higher than desired AR and denial rates.
Fix: Converted to the CEDI platform for Claims, Remit, Eligibility, HCM and DIQ
Results:
“The transition was beyond easy, it was a smooth process. The HealthCo implementation team even monitored my first week of claims to make sure there were no glitches.
Our collections have improved by over 20% and the doctors are VERY HAPPY!”
Clinic Profile:2 Ortho Surgeons1 PT2 locations including an ASC
Contact:Melissa Miller, Billing [email protected]
EDI Services integrates payer informationdirectly into the financial management process
$220BProcessed annually by Centricity EDI Services
620MTransactions processed annually by Centricity EDI Services
10+ YearsStaff average EDI experience
Claim Submission Payer Integration Advanced Payment
Tracking
Analytical dashboard
AnalyticsDenial & rejection
management
Auto Claim Status Inquiry
Payment Automation
Claim Scrubbing
Eligibility2,100+Clients utilizing EDI Services from GE Healthcare
Service model
GE Healthcare Service Model
• Single vendor solution
• We design, build, and maintain transaction setup
• GE Healthcare provides All Payer Connectivity
• 24/7 Production Control monitoring on all transactions
Proactive Monitoring & Support
• Production Control Team
• Monitoring Tools
• Performance Metrics
Integration
• Built-in to Practice Management System
• Centricity EDI is part of core workflow
Focus on Revenue Cycle:
• Payer Edits
• Claim Scrubbing
• Clean Claims
• Reduce Rejected Claims
• Reduce Denied Claims
• Reduce days to Payment
• Increased cash flow
Work Flow Efficiency:
• Automation
• Reduce Re-work
• Improve process
Centricity EDI Services Overview
Insurance eligibility checking
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Centricity EDI’s Eligibility Verification allows customers to utilize a highly automated exception-based workflow to
quickly verify patient eligibility
• Why Eligibility:• Improve customer’s ability to collect full or partial
payment (copay to deductible)
• Inform the patient of their financial responsibility at the time of arrival – particularly with High-deductible Health Plans (HDHP)
• Prevention of rejections & denials
• Reduce labor costs and improve productivity (fewer phone calls!)
Centricity EDI Services: Transaction Flow
HTTPSCentricity PM
Centricity® EDI Services Real-time Data Center
Centricity EDI Services owns setup and ongoing maintenance
Full integration with Centricity PM
Real-time Production Control 24/7
Store and Forward
EHNAC and CORE
Payer
Trading Partner
Payer
Payer
Payer
Payer
271 Response
270 Request
Payer
Transactions monitored for response and timeliness
Average response time is 10-20 seconds
Centricity Practice Solution integrated eligibility workflow
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Insurance claim submission
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Customers utilizing GE’s claims service enables an integrated, complete
workflow coupled with near 100% electronic coverage
Why Electronic Claims:• High % of electronic claims saves money
• EDI Dashboard for real-time file and claim tracking
• Extensive claim, remittance, and denial reporting
• Integrated product ensures efficient workflow and follow-up
• Proactive monitoring reduces insurance follow-up time
• Same day delivery of claims & acknowledgement reduces cycle time
EDI Dashboard
• Real-time insight into claim and remittance tracking
• Centralized view of payer mandate updates
• Summary of top rejections and denials
• Detailed insights into payer rejections as well as suggested actions
Claim file tracking
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Production Control
Payer Edit Integration (PEI)
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Integration of front-end (pre-adjudication) edits received from clearinghouse and/or payer
Provides integration into the Claims Tab while updating the status of
tickets
Why Payer Edit Integration:
• Insurance follow up from Centricity Practice Solutions
• “Root cause” reporting from Centricity Practice Solutions
• Reduction in rejection rate
• Improves resolution time and reduce time to completion
• Integration with Centricity Practice Solutions
Integrated EDI edits in Centricity Practice Solution
Electronic remittance advice
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Centricity EDI Services remittance submissions provides near 100% electronic remittance
transactions posted directly into your practice management system
Integration enables standardized denials and high auto-post rates
After posting, standardized analytics to help you identify denial trends
Why Electronic Remittance :• A connected product supports more efficient
workflow and follow-up
• Labor savings by automatically posting and integration
• Use of standard denial codes to drive automation and process improvement
• Same-day delivery supports faster follow-ups
• Extensive ERA file history and check summary reporting
• Ability to re-queue missing ERA files on the fly
Payment posting integration
ERA file history & check summary
Reconciliation and real-time file tracking made easy
Remit Summary – Denial Category
Customize denial reporting to identify workflow inefficiencies
Hosted Claims Manager and DenialsIQ
Claim scrubbing
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Hosted Claims Manager is a rules-based, front-end clinical editing
tool that allows you to review claims before submission
Reduce claim denials Shorten your accounts receivable
cycle
Increase the rate of collections
• Why Hosted Claims Manager:
• $25 average cost per claim for rework*
• 15% industry average for claims that are rejected or denied*
• Clinical edits are integrated into your approval process
• Real time response • Rules updated bi-weekly • Low implementation effort
* Source: Optum, 2015
Claim scrubbing
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• Proven, industry-leading clinical editing engine including LMRP/NCD/LCD
• Edits can be created specific to your local payers guidelines
• Edits can be turned off if not needed
Submit
Correct
Scrub
Clinical edits...What are they?
Duplicates
Established/New Patient
Medicare Local Coverage Determinations/ National Coverage Determinations (LCD/NCD)
Correct Coding Initiative Edits (CCI)
Bundling Edits
Modifier relationship to procedure code
Diagnosis relationship to procedure code
Maximum frequency
Global periods
Injection codes
DenialsIQ
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Advanced statistical algorithms from GE Global Research identify
patterns by root cause factors
DenialsIQ automatically surfacesunseen patterns in denials to help
capture missed opportunities
Focus teams on resolving the denials rather than finding the denials
• Why DenialsIQ: • Built on Predix™, follows
Fastworks development methodology … quick to respond to change
• Alert and share invoice details with staff to take necessary action to resolve claim denial
• High cost to rework denials • 2% denials write-offs equaled
of net patient revenue*• *Advisory Board Revenue Cycle Benchmark Study
DenialsIQ
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• Dynamic visualizations help prioritize opportunities to work denials more quickly
• Defines pattern details and root cause to prevent future occurrences
• Advanced dashboards filter in order to monitor and report performance over time
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DenialsIQ Dashboards
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DenialsIQ Dashboards-By Category
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DenialsIQ Dashboard Filters
DenialsIQ and Hosted Claims Manager
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Hosted Claims Manager is an ideal complementary solution to DenialsIQ, our advanced analytics solution that uncovers unseen trends based on your claim denials.
Uncover coding patterns/denials in DenialsIQ then look to what can be resolved with Hosted Claims Manager to prevent future denials and rework; thus creating a closed loop solution.
What is Next?
Payor Provider Connect
Summary
Benefits of Centricity EDI Services
Clean Claims Improve financial performance Workflow Efficiency Reduce costs True Integration – built in! Value added services – single vendor Compliance
Pricing Overview:
Bundle #1:
Hosted Claims Manager and Denials IQ
Bundle #2:
CEDI Claims,Remit, Eligibility
43 % Savings
13 % Savings
Bundle #3:
Full CEDI Program
26 % Savings
Special Pricing Expires 3/15/17
>
Resources
• GE CEDI Information including case studies and brochures
For product questions and information:
For pricing details and questions about your current EDI tools:
