BILLING SOLUTION User Guide Version 1.1 9/10/2015 TABLE OF CONTENTS ABOUT THIS DOCUMENT... 2 REPORT CODE DEFINITIONS...2 BILLING SOLUTION OVERVIEW... 2 ROCK-POND REPORTS DIVE IN... 2 IS MY PRICING CORRECT?...2 HOW MANY UNCONFIRMED TICKETS DO WE HAVE & HOW OLD ARE THEY?...3 WHAT TICKETS ARE ABOUT TO REACH THE TIMELY FILING DEADLINE?...3 WHAT AUTHORIZATIONS ARE ABOUT TO EXPIRE?...4 ARE MY TICKETS CORRECT BEFORE I BILL THEM?...4 WHAT ARE MY BILLERS DOING?...5 ADDITIONAL REPORT GROUPS...5 CPR+ ANALYTICS DASHBOARDS MANAGE... 6 CPR+ ANALYTICS COMPANY SETUP...6 DASHBOARD REIMBURSEMENT SUMMARY...6 Scorecard Current AR...7 Scorecard Credit Balances...7 Scorecard AR over Threshold...7 Scorecard Unbilled Revenue...7 Scorecard Current Pending Revenue...7 Scorecard Billing Review Revenue...7 Scorecard Revenue Today...7 Scorecard Cash Today...7 Trend Graph Cash vs Revenue Trending...7 Gauge Cash vs. Goal...8 Gauge Revenue vs. Goal...8 Gauge DSO vs. Goal...8 Gauge Profit vs. Goal...8 CPR+ ANALYTICS CUBES - ANALYZE... 8 CUBE TICKET CUBE...8 Global Layout Unconfirmed Ticket by Shipping Method...8 Global Layout Unbilled by Ready to Bill Status...9 Global Layout Unbilled Tickets in Billing Review...9 Billing_Solution-User_Guide.docx Page 1 of 9
ABOUT THIS DOCUMENT This User Guide will get you started with the reports, dashboards and cubes that are a part of the Billing Solution. Rock-Pond groups all of its business intelligence content (reports, dashboards and cubes) into one of 8 solutions. We recommend a 3 step approach, DIVE IN, MANAGE AND ANALYZE to understand what is available and begin using Rock-Pond products effectively. 1. DIVE IN to the reports there are many reports in the billing solution, grouped into report groups and a catch all report group called other. This document will go through the most commonly used reports in the business solution. Once you understand and master these you will be able to go through the other report groups to find what you need. 2. Review the dashboards to understand how they will help you MANAGE your business. Dashboards provide a high level view of metrics that give you access to critical information at a glance. This document will provide an overview of each metric on the dashboard, why it is there and how you can use it. 3. Review the data groups and global views available in the cubes to help you ANALYZE information at a deeper level. 4. Finally, Appendix A and B to have an understanding of all Solutions and how Rock-Pond can assist you further. REPORT CODE DEFINITIONS All reports have the same code but depending on what version of CPR+ you are on (Line Item Financials or Legacy) will depend on the prefix. Legacy will start with!c2_ and Line Item Financials will start with!c3_. Please make note of the system you are on to find the correct report. BILLING SOLUTION OVERVIEW The goal of any billing department is to make sure everything is billed as soon as possible without anything falling through the cracks. Effectively managing all aspects of your billing process can be difficult; however, when given the right tools, the INFORMATION you need to manage the billing cycle, avoid denials, and monitor biller productivity can be accessible at your fingertips. The Billing Solution is proven to answer these questions and more. ROCK-POND REPORTS DIVE IN IS MY PRICING CORRECT? 1124 CONTRACT PRICING BY CONTRACT WHERE EXPECTED IS MORE THAN {} GREATER THAN BILLED REPORT Building accurate contracts and maintaining them are an absolute necessity. By correctly setting up your payer contracts, your organization's revenue will be booked correctly, eliminating denials, incorrect payments, and lost revenue and reducing the need for revenue adjustments. It will allow the person in charge of setting up contracts in your system audit the contracts for incorrect information, such as any pricing discrepancies that should be corrected in order to eliminate billing errors. Follow these steps to see inventory items where the variance between billed and allowable is greater than an amount in order to easily identify pricing issues. Billing_Solution-User_Guide.docx Page 2 of 9
Launch the 1124 report to see instances where your contract pricing may be set up incorrectly in your system. To begin, enter a variance of 0 in the parameters in order to see all cases where the expected amount is greater than billed. Briefly scan through the variance column to find an item with a larger number. The greater the number, the more likely there is some type pricing issue in the contracts in your system. Look up that contract in your pricing matrix of CPR+ and correct the issue. Once all pricing discrepancies are resolved, establish a plan to run this report on an ongoing basis in order to prevent problems down the road. This report can be validated by looking up individual payer contract pricing in the Insurance Companies Database and compare the expected price and the list price for each item. HOW MANY UNCONFIRMED TICKETS DO WE HAVE & HOW OLD ARE THEY? 1169C UNCONFIRMED DELIVERIES ANALYZER Delays in billing are often caused by delays in delivery confirmation. Being diligent in confirming your tickets will insure that revenue is captured quickly and allow billers to invoice payers for services before timely filing deadlines. Your process for confirming delivery tickets must be standardized because delivery tickets that sit in the unconfirmed status are dragging down your reimbursement process. If staff waits until the end of the month to confirm large amounts of tickets, the billers are overworked when trying to bill out before close. Our Unconfirmed Deliveries Analyzer can be run throughout the month to manage the delivery confirmation process and increase your efficiency. Try looking at the INFORMATION like this: Run 1169c for only DELIVERY TICKETS, which will exclude pickup tickets from the report. Change the primary grouping to TICKET THERAPY and enter yesterday s date to base the report. Choose to not show ticket detail so you will have a nice summary report of your unconfirmed delivery tickets. Notice the total number of unconfirmed tickets, as well as, the number of unconfirmed tickets for each therapy. If you don t use anything other than internal drivers, change the primary grouping to DRIVER ASSIGNED and rerun the report. Take note of any driver who has an outstanding number of delivery tickets. Then rerun the report to show ticket detail, drill down on that driver, and contact them to figure out what the issue is. If you use couriers (i.e. UPS, FedEx) for most of your tickets, run the report by SHIP METHOD and show detail. Then you can see any unconfirmed tickets for that shipping method. For instance, you could drill down on unconfirmed tickets that were supposed to be shipped via UPS, check the tracking number, and if it has been delivered, confirm the ticket. This report can be validated by using the [Rock-Pond] Unconfirmed tickets by Shipping Method global layout or the Delivery Ticket Confirmation Manager in CPR+. View the ticket and click on the Pre-Invoice tab in order to check for the ticket s cost, billable expected, and billable list. WHAT TICKETS ARE ABOUT TO REACH THE TIMELY FILING DEADLINE? 1329A TIMELY FILING ALERT - UNBILLED TICKETS REPORT Having to write off a service provided because you did not meet a timely filing deadline is unacceptable. CPR+ allows you to setup filing deadlines. By entering these deadlines into your system, Rock-Pond can alert you of those unbilled tickets that are reaching the deadline, which will allow you to focus staff on the right issues and Billing_Solution-User_Guide.docx Page 3 of 9
eliminate denials for timely filing. To manage your unbilled tickets, use our Timely Filing Alert Unbilled Tickets report. Follow these steps as a quick-start: Run the report using the default parameters which will show tickets that are within 15 days of the timely filing deadline and will enter 90 as the default timely filing deadline for insurances without timely filing days setup in CPR+. Notice any tickets indicated in red on the report. These tickets are already past the timely filing deadline, which means that each red line is more than likely a missed opportunity. Therefore, it is important to run this report on a weekly basis in order to prevent your report from going red in the future. Now focus on the tickets in black on the report. These tickets are the ones that you must focus on because they are within 15 days of your timely filing deadline. If they aren t billed by the deadline, you will not get paid for the services you provided. This report can be validated ticket by ticket manually by following these steps in CPR+. First, you need to look at the individual ticket and its date of service and payor. Go to that payor setup and confirm the timely filling deadline (Question 24 of Payor Setup). Then count the number of days from the date of service of that ticket to today to see if the unbilled ticket is reaching the deadline. WHAT AUTHORIZATIONS ARE ABOUT TO EXPIRE? 1323 EXPIRING AUTHORIZATIONS BY PATIENT WITHIN PAYOR EXPIRING {} THROUGH {} REPORT Tracking authorizations is crucial to the success of your billing department. If you provide a service without a payer s prior authorization, it will more than likely result in delayed payment, unnecessary denials, and/or inability to receive an authorization for future service. Our Expiring Authorizations report shows you patients with authorizations that will be expiring so you can work them on an ongoing basis and prevent billing issues. Run the 1323 report for this month to see authorizations that will be expiring for that date range by patient within payer. Select ACTIVE as the patient status to only show expiring authorizations for patients that are still on service. Click on the Toggle Group Tree icon in the upper left hand side of the report screen and expand the Sites to see the list of all payers included on this report. Locate one payer, such as BCBS, and click on it in the toggle tree in order to go to that specific payer in the report. Now double click on the payer in order to drill down on only the authorizations needed from that payer. Print the report and contact BCBS to retrieve new authorizations for every active patient for that payer in one single phone call. This report can be validated by using the Authorization Tracking report in CPR+. Make sure the date range and patient status to include match with the 1323 report. ARE MY TICKETS CORRECT BEFORE I BILL THEM? 1171CZ CONFIRMED DELIVERY TICKETS AUDIT REPORT The best way to solve a problem is to prevent it in the first place. One more set of eyes each day on confirmed delivery tickets will improve the quality of DATA for your billing department. We recommend creating a daily ticket audit process to prevent billing errors. Our Confirmed Delivery Tickets Audit report is a powerful tool that includes a 6-Point Review Checklist that guides the review of each delivery ticket each day. As billers have issues or claims are denied, review your audit process and identify ways to catch more problems before they become billing errors. Try this: Billing_Solution-User_Guide.docx Page 4 of 9
Run 1171cz for yesterday s date to audit the tickets that were confirmed for the previous day. Choose to show OPEN AUTHORIZATIONS, include CONFIRMED TICKETS ONLY, UNBILLED TICKETS ONLY, and EXCLUDE PICKUP TICKETS in the report parameters. Go through the 6-point review checklist as shown on the report to make sure the DATA entered into your system for these confirmed delivery tickets is correct. If there are any inconsistencies, go into your CPR+ system and make the appropriate changes. Note that an X beside an item on the ticket indicates that it is a billable item. Once every ticket has been reviewed and corrected, refresh the report to see the changes and to make sure there are no further issues. This can be validated by manually looking up ticket by ticket in the system through the Ready to Bill Manager. The Therapy, Ticket #, and Patient can be seen in the manager and the quantity, cost, billable expected, billable list, and the confirmed date can be seen when you go into the individual tickets. WHAT ARE MY BILLERS DOING? 2018 EMPLOYEE PRODUCTIVITY SUMMARY A great way to monitor the productivity of your department is by looking at a big picture of metrics that drive your billers. The Employee Productivity Summary provides a summary of what your billers are doing. It will help you accurately measure who is creating revenue and measure the volume of claims and patients a billing clerk is working on. Dive into the report to see how your billers are doing: For a high level look at the productivity of your billers, run the 2018 report. This report will show a summary of the revenue, payments, denials, and notes for each of your employees to measure productivity for the date range of your choice. Use it to set standards, create goals and evaluate your employees. Since it is grouped by the job function that each user is assigned in CPR+, locate the yellow line on the report that says BILLING to drill down on only those in billing and easily compare the progress of each biller. Select one of the employees listed, such as a biller that doesn t appear to be as productive as others, and double-click on that individual s name. Notice under their name in the new grouping that the transaction types CASH, NOTES, and REVENUE are listed. Each of these transaction types can be drilled down on to see a detailed look at each of these areas in order to determine why their goals are not being met. * Productivity is based upon the user that creates the transaction, not necessarily the person that processes it. This report can be validated by using various CPR+ Reports, Rock-Pond reports, and CPR+ Analytics Cubes, all grouped by users. The products are as followed: The Revenue report, 1243 - Revenue Analyzer (or Revenue Cube), the Cash Aging, 1245az - Payment Aging Analyzer (or Cash Cube), the 1245bz - Adjustment Aging Analyzer (or Adjustment Cube), and the Note Manger or Billing Note Analyzer. ADDITIONAL REPORT GROUPS The Billing Solution contains the following report groups. To see the reports in each of these groups, view all reports in the Rock-Pond Information Center grouped by Solution + Report Group Competitive bidding The reports in this report group provides an impact analysis for providers based on the HCPC codes and Competitive Bidding Areas (CBAs) included in the Round 1 and 2. Billing_Solution-User_Guide.docx Page 5 of 9
Contract Management The reports in this report group provide you with an overview of your insurance set up in order to audit different aspects of business such as contract pricing, Timely Filing The reports in this report group provide you with the tools to audit your billing system for missing information, correct it, and eliminate timely filing denials all together. CPR+ ANALYTICS DASHBOARDS MANAGE CPR+ Analytics enables you to see your business at the big-picture level using dashboards and analyze at the deepest level using cubes. The following is an overview of the dashboards and cubes provided with the billing solution. CPR+ ANALYTICS COMPANY SETUP The following settings are required for the dashboard and cube in this solution to function accurately: Fix targets Cash vs. Goal DSO vs. Goal Profit vs. Goal Revenue vs. Goal Settings Based on age, how many days old is OLD AR? DASHBOARD REIMBURSEMENT SUMMARY The Reimbursement Summary dashboard combines need-to-know data with CPR+ Analytics at a glance Philosophy. With a quick glance, anyone can see where Cash, Revenue, and Profits stand and how the goals set for each month are being met. Billing_Solution-User_Guide.docx Page 6 of 9
The following is an overview of each dashboard element, including the process to validate or dive deeper. SCORECARD CURRENT AR The Current AR element allows users to quickly see the total amount of AR for the organization. The amount represented is as of the last AR feed, which defaults to nightly. Run the 1234z AR Aging Analyzer or the AR cube to validate this scorecard and dive in deeper by changing the grouping options to determine current AR by key indicators. SCORECARD CREDIT BALANCES It is very difficult to see credit balances in CPR+ because so often patients who have credit balance invoices also have invoices with a positive balance and a net balance. Managing your credit balances will help keep your AR accurate and reduce liability from owing patients and payers money. This element shows the total balance for invoices less than zero. Run the 1234z AR Aging Analyzer or the AR Cube and choose to see only Credit Balances to validate this scorecard. SCORECARD AR OVER THRESHOLD The AR over Threshold element allows users to quickly see the amount of the AR over a certain days, as set up in Company Setup Based on age, how many days old is OLD AR? Run the 1234z AR Aging Analyzer to validate this scorecard and note the threshold. For example, if you pick your threshold to be 90 days, the AR over Threshold scorecard should match with the AR for 90 and over aging bucket. SCORECARD UNBILLED REVENUE The Unbilled Revenue scorecard is the current total of the expected amount on billable items on delivery tickets that are confirmed but have not been assigned to an invoice. Run the 1025j Unbilled Aging Analyzer to validate the Unbilled Revenue. Group by different options to see Unbilled Revenue based on key indicators. SCORECARD CURRENT PENDING REVENUE The Pending Revenue scorecard shows the expected revenue on invoices that have been created but are pending. Run the 1243f Pending Revenue Analyzer to validate the current pending revenue. The report will ask for a date range and an all time period should be entered to include all of the pending revenue. SCORECARD BILLING REVIEW REVENUE This Billing Review Revenue element shows the total amount of revenue of invoices that are being reviewed for billing. Run the 1348 Combined Unbilled Extract Report and export it to Excel (Data only). Then, filter it on Billing Review Status so it only shows Yes status and sum up the Gross Expected Amount. Validate this figure with the element. In addition, you can also use the global layout to validate this figure. SCORECARD REVENUE TODAY The Revenue Today scorecard quickly display the amount of revenue billed today. Run the 1243 Revenue Analyzer report and pick today as the date range to validate this element. SCORECARD CASH TODAY The Cash Today scorecard quickly shows the amount of cash posted for today. Run the 1072z Cash Posting Journal and pick today as the date range to validate this scorecard. TREND GRAPH CASH VS REVENUE TRENDING This element is used to monitor the amount of cash posted this month versus the amount of revenue billed including revenue adjustments. Run the 1243 Revenue Analyzer report and 1245az Payment Aging Analyzer. Pick the current month as the date range and validate this trend graph. Billing_Solution-User_Guide.docx Page 7 of 9
GAUGE CASH VS. GOAL Identify the Cash target and enter it into the fixed target for the current month in company setup. Then use this element to monitor if cash goals are being met throughout the month. The arrow points to where the cash goal is set and the red line shows where the company stands for the month as compared to the goal. The figure below allows users to quickly see the amount of cash needed to meet the monthly goal or whether the cash posted has already exceeded the target and by how much. Run the 1245az- Payment Aging Analyzer and pick current month as the date range to validate this gauge. GAUGE REVENUE VS. GOAL Identify the Revenue targets and enter it into the fixed target for the current month in company setup. Then use this element to monitor if revenue goals are being met throughout the month. The arrow points to where the revenue goal is and the red line shows where the company stands for the month as compared to the goal. The number below allows users to quickly see the amount of revenue needed to meet the monthly goal or whether the revenue has already exceeded the target and by how much. Run the 1243z Revenue Analyzer and pick current month as the date range to validate this gauge. Since it takes in account Adjustment, also run the 1245bz Adjustment Aging Analyzer by Billed Month and Adjustment Type to identify any revenue adjustment. GAUGE DSO VS. GOAL Our DSO formula is a simple calculation of your AR balance divided by the average revenue per day for a period. Identify the DSO target values and enter it into the fixed target for the current month in company setup. Then use this element to monitor if DSO goals are being met throughout the month. The arrow points to where the DSO goal is and the red line shows where the company stands for the month as compared to the goal. The figure in the element is the number of days below or exceed the goal DSO. Run the 1357 DSO Analyzer to calculate your DSO as of today s date to validate this gauge. GAUGE PROFIT VS. GOAL Identify the Profit Percentage targets and enter it into fixed target for the current month. Then use this element to monitor if the profit percentage goals are being met throughout the month. The arrow points to where the percentage goal is and the red line shows where the company stands for the month as compared to the goal. The number below allows users to quickly see the amount of profit percentage needed to meet the monthly goal or whether the percentage has already exceeded the target and by how much. Run the 1184b Profitability Analyzer report and pick current month to validate this gauge. CPR+ ANALYTICS CUBES - ANALYZE CUBE TICKET CUBE The ticket cube is designed to compile all tickets at the line item level. It will give the users the ability to sort by any field desired for a quick analysis of ticket level details, for example, unconfirmed or unbilled tickets. GLOBAL LAYOUT UNCONFIRMED TICKET BY SHIPPING METHOD The layout [Rock-Pond] Unconfirmed Ticket by Shipping Method was made global for all users. It will give you an overview of all tickets that are unconfirmed by shipping method, sorting by the oldest ticket. Discover the layout Billing_Solution-User_Guide.docx Page 8 of 9
in the drop down list or within the layout manager and use it as a starting point to manage your unconfirmed tickets. Here is how we built this layout: Row Area: Ticket Delivery Date, Ticket Site Name, Ticket Shipping Method, Ticket Driver, Ticket Number, and Patient Full Name. Filter Area: Ticket Type (filter to show Delivery only), and Ticket Stage (filter to show Unconfirmed only). Data Area: Ticket Item Extended Expected (Note that this is the Expected from the ticket) Sort it by the oldest Deliver Date GLOBAL LAYOUT UNBILLED BY READY TO BILL STATUS The layout [Rock-Pond] Unbilled by Ready to Bill Status was made global for all users. This layout gives you an overview of all the tickets that are confirmed but have not yet been billed by Ready to Billed Status. Discover the layout in the drop down list or within the layout manager and use it as a starting point to manage your unbilled. In order to build the layout, these are the steps you need to do: Row Area: Ticket Site Name and Ticket Ready to Bill Status. Column Area: Ticket Stage (filter to show Unbilled only). Filter Area: Ticket Type (filter to show Delivery only). Data Area: Ticket Item Extended Expected (Note that this is the Expected from the ticket) GLOBAL LAYOUT UNBILLED TICKETS IN BILLING REVIEW The layout [Rock-Pond] Unbilled Tickets in Billing Review was made global for all users. This layout will give you a look at your billing review and show corresponding payment as well as ticket number. Discover the layout in the drop down list or within the layout manager and use it as a starting point to manage your delivery tickets that are in Billing Review. In order to build the layout, these are the steps you need to do: Row Area: Ticket Billing Review Status, Ticket Payor, Patient Full Name, and Ticket Number. Column Area: Ticket Stage (filter to show Unbilled only). Data Area: Ticket Item Extended Expected (Note that this is the Expected from the ticket) Filter Area: Ticket Type (filter to show Deliver only) and Ticket Billing Review (Y/N) (Filter to show Yes only). Billing_Solution-User_Guide.docx Page 9 of 9