AUGUST 9, Office Manager: Using Workflow Organization Basis

AUGUST 9, 2016 Office Manager: Using Workflow Organization Basis

AUGUST 9 11, 2016 ACE 2016

Introductions Dana Corkern, Solution Manager for Allscripts PM Have been with Allscripts for 12 years Prior to joining the Allscripts team, worked for a several Allscripts clients for 9 years. Copyright 2016 Allscripts Healthcare Solutions, Inc. 3

Introductions Unity Healthcare, LLC has several locations around the Lafayette, Indiana area and uses Touchworks EHR, Allscripts Practice Management, Payerpath and Follow My Health Unity has been an Allscripts client since 2001. Prior to implementing Allscripts Practice Management, they were a long time Allscripts Vision client Tanya Richardson is a Application Systems Manager for the Allscripts applications Heather Dawson is the Central Billing Office Manager and manages 33 employees Unity Healthcare has about 200 providers Their organization employs over 665 talented personnel Copyright 2016 Allscripts Healthcare Solutions, Inc. 4

Unity Healthcare Office Manager Overview Unity has 5 production databases Largest database has 55 departments Total average claims moving through Office Manager daily 31,000 claims Average days in A/R - 31 Copyright 2016 Allscripts Healthcare Solutions, Inc. 5

Unity Healthcare Collector Breakdown Self Pay Collection representatives = 4 Insurance Follow-up representatives = 17 Refund Specialist = 3 Payment Posters = 6.5 (no online bill pay at this time) Reimbursement Specialist = 1 Claims/Statement Specialist = 1 Scanner =.5 Copyright 2016 Allscripts Healthcare Solutions, Inc. 7

What is Workflow Organization Basis?

Simply put It is the hierarchical definition of how you work your pending claims and unpaid claims After you define a basis, the following occurs: The select records that correspond to your basis criteria are disabled in Work Queue Maintenance Operators are assigned to work queues using your defined basis criteria in Workflow Organization Maintenance Vouchers are assessed by the system using the criteria selected for the WOM and WQM records and assigned to a queue IMPORTANT NOTE: a voucher can only be assigned to one queue at a time and this is done based on the order of priority set in WOM Copyright 2016 Allscripts Healthcare Solutions, Inc. 9

Unity Healthcare, LLC Workflow Organization Basis Setup First the system looks for Practice/Department specifications Second the system looks for Insurance Reporting Class specifications Last the system looks for any Actual Provider specifications Copyright 2016 Allscripts Healthcare Solutions, Inc. 10

Understanding Setup: Workflow Organization Basis - Pending Claims

Pending Claims Held Vouchers Create all the Held Voucher reasons in HVM Possible to filter by: Providers Departments or Practice Insurance Carriers Locations Hold Status Copyright 2016 Allscripts Healthcare Solutions, Inc. 13

Workflow Organization Maintenance Management Category Pending Claims You can filter and create WOM s based on basis selected Add Work Queues for the WOM Attach the operators Copyright 2016 Allscripts Healthcare Solutions, Inc. 18

Office Manager Pending Claims Management Basis is by Department/Practice Sorted by queues: Pending Claims Electronic Pending claims Office Held Vouchers Pending claims - Paper Copyright 2016 Allscripts Healthcare Solutions, Inc. 19

Understanding Setup: Workflow Organization Basis - Unpaid Claims

Unity Healthcare Unpaid Claims Setup Work each Department/Practice independently Practice LOC large practice for Unity Healthcare 3 classifications used per Department/Practice: Office Denials INS CBO The Office items are pushed to the office to be worked by practice staff Denials and INS CBO are worked by Central Billing Office staff Client breaks unpaid/un-responded claims by carrier groupings: Commercial Government (Medicare, Medicaid, Tricare, etc.) Copyright 2016 Allscripts Healthcare Solutions, Inc. 22

Office Manager All Setup Now What?

Denial and INS CBO Work Queues Follow-up staff process Claim Notes are added by Central Billing Office staff Notes allow for productivity tracking Notes add routine messages to claim without manual typing Notes guide follow-up staff on appropriate follow-up days to assign based on the note Indicated by parenthesis behind the note description Copyright 2016 Allscripts Healthcare Solutions, Inc. 33

Office Manager Grouping Option Drag the Payor to the column header to group by Group by: Payor Service Date Patient Provider Age Follow-up date Etc Copyright 2016 Allscripts Healthcare Solutions, Inc. 34

Unity Office Manager Work Queue Example Can be sorted by column headers F/U Date helps keep claims worked in appropriate time frames Payor column allows you to see any trending with outstanding claims Balance allows claims to be worked by outstanding dollar amount for high dollar claims Copyright 2016 Allscripts Healthcare Solutions, Inc. 36

Process for sending claim to office Select a Voucher / Claim from Unpaid Claims Management Collector right clicks on voucher/claim and selects Claim Notes Add ADDOFF claim note to drive the claim to the Office queue. Collector enters note with the required information Copyright 2016 Allscripts Healthcare Solutions, Inc. 37

Continued Process Office staff has 7 days to respond After providing the Requested information or making the necessary Corrections, the office staff Right clicks and adds the Note Type = *Claim Note and changes the follow-up date to Today This process will push the claim back to the CBO s queues to be reviewed and processed Copyright 2016 Allscripts Healthcare Solutions, Inc. 38

Office Manager Productivity Reporting

Productivity Reporting Crystal Reports Report pulls all claims notes added for the previous week for each Central Billing Office followup staff member Summary (shown) or detailed report can be reviewed for supervisory evaluation Copyright 2016 Allscripts Healthcare Solutions, Inc. 40