CLAIMS & REMITTANCE.

Transcription

1 CLAIMS & REMITTANCE

2 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 geoff@epic.com 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.

3 Goals

4 Agenda Claims Regulation & Collaboration Remittance Discuss Future Directions

5 Claims Overview Claim Values Update Automating Content Automating Transmission Reporting

6 Claim Values & You

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9 Pretty Cool, Right? Did everyone see the difference? No?

10 Hint: <- This Guy?

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

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13 Now This is Happening: Claims Processing Logic derives claim values after processing Claims Printing Printer File Form printing simply maps CEV items to claim fields

14 Nutshell Discrete record of entire claim Powerful rules-based configuration Platform Synchronize electronic & paper image Cancel claims CEV-driven error rules Vision

15 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

16 Getting Started New UserWeb documentation Now with 86.4%* more screenshots & examples Work with TS Up-to-date information Continuing to release content Feedback?

17 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

18 Why Rules? Suppose I only send V04.81 on flu vaccine claims But I administer vaccines while providing other services! <- No Problem!

19 After 10/1/2014. D oh! <- Problem! until:

20 Now 10/1 will be easy*! D oh! <- Problem! Voilà:

21 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

22 With Great Power Performance

23 Delivering the Claims

24 Delivering the Claims Securely transmit electronic claims from Epic Send 837 directly to payors or intermediaries SFTP, FTPS, HTTPS via Interconnect

25 Why Transmit? Timing Today Tomorrow If you can send, you can re-send Connectivity limits IT intervention?

26 Reconciling the Claims

27 Reconciliation [screenshot] ***

28 Error Reporting

29 Claim Errors Dashboard ***

30 Claim Errors updateme [screenshot] [screenshot] [screenshot] ***

31 Claim Errors Drilldown ***

32 Productivity

33 Claim Edit Productivity

34 Collaboration Overview Recent Regulatory Updates Process ICD-10

35 Revised CMS-1500 Condition codes Diagnosis list ICD indicator Date qualifier Provider qualifier Resubmission code label Other labels, text & removals

36 Sequestration [screenshot] Show build document

37 Ongoing Collaboration Bulletins Not-just-HIPAA calls UserWeb Opportunities to share best practices Ways to apply & get the most out of the tools

38 Collaboration Ideas?

39 Professional Dual Coding

40 Cutover Control Payor preferred codeset New form-level option Allows carving out scenarios

41 ICD-10 Updates UserWeb Forum Calls & webcasts Bulletins Testing updates

42 Remittance Overview Cash Reconciliation Workflow Reporting

43 Payments & Deposits & You

44 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

45 Step-by-Step Cash Matching Money Cash deposited into bank Now can be imported! EOB/Remittance Payment/remittance created based on EOB Cash records created in Epic, balancing bank money Reprocess if cash comes in after Remit Payments matched to cash records Payment filed/posted as transactions

46 Remittance [screenshot] [screenshot]

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48 Cash Management

49 Cash Summary [screenshot]

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51 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?

52 Pop Quiz

53 Less is More Schedule gone. Auto-tune, queue priority Scan gone.

54 Less is More Schedule gone. Auto-tune, queue priority Scan gone.

55 Less is More Schedule Auto-tune Background Scan Load errors

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57 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

58 Reload

59 Reload & Remove Why?? [screenshot] [screenshot]

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61 Review

62 Reporting [screenshot] [screenshot]

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64 Key Takeaways Claim values Mid-day claim run Claim reconciliation Remittance reconciliation Regulation Collaboration

65 Discuss Future Directions Focus groups Attachments & clinical documentation Expand edit More real-time tools Better ways of sharing content

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