insurance ar followup - healthsystemshealthsystems.net/docs/hs_ins_ar_follow_up_ii_05252010.pdf ·...
TRANSCRIPT
Insurance AR FollowupAida Anderson and Karen Lands
2010 HealthSystems
Webinar Series
May 25, 2010
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Agenda for TodayAR Reports• AR Reports� What is represented on the report?
• AR and Billing Components/Criteria• AR and Billing Components/Criteria� Use this valuable tool to review problem Financial Classes
• Billing spreadsheet/Columns/Sort• Billing spreadsheet/Columns/Sort� Manipulate columns and sort columns for quick review
• Drill down into visit• Drill down into visit� Transaction Tab
� Notes tab/Centricity Scrub
� Claims tab/Clearinghouse and Payer response� Claims tab/Clearinghouse and Payer response
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A/R Defined
Accounts receivable (A/R) is one of a series of accounting transactions dealing with the billing of a customers for goods and servicesreceived by the customers. In most business entities this is typically done by generating an entities this is typically done by generating an invoice and mailing or electronicallydelivering it to the customer, who in turn delivering it to the customer, who in turn must pay it within an established timeframe called credit or payment terms called credit or payment terms
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Financial Class Defined
Financial classes identify and track groupings of patients for reporting purposes. They also determine which fee schedules are used. A financial class can be Private Pay, Medicare, Medicaid, PPO, Self Pay, etc. Medicare, Medicaid, PPO, Self Pay, etc.
The Financial class associated with the primary insurance will be the financial class primary insurance will be the financial class defaulted for a patient
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Entered in Registration/Insurance
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F/C will be defaulted on visits created
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Modifying Financial Class
FC can be changed within the visit-without
modifying Patient Registrationmodifying Patient Registration
• Work Comp
• Auto Accident• Auto Accident
• Self Pay
Financial class is locked in when batch is closedFinancial class is locked in when batch is closed
Money owed on a visit will remain in the financial class for reporting purposes, regardless of class for reporting purposes, regardless of responsibility
What report shows AR by F/C?
• Aging by Financial Class– This report lists accounts receivable for patient and insurance balance totals by financial class. The totals are separated by aging category. The difference between this report and the Procedure Date Aging by Financial Class report is that this report takes all account activity (for example, balance forwards and transferred report takes all account activity (for example, balance forwards and transferred balances) into consideration when aging the balances. The Procedure Date Aging by Financial Class report ages based on the Date of Service/Date of Entry of the procedures only and does not restart based on other account activity.
– This report is useful in analyzing what financial classes generate the highest percentage of accounts receivable and where those figures fall in the aging categories, which could assist in collections efforts or financial planning for your office. Specifically, this report could be used to analyze negotiated contracts with various insurance carriers according to their assigned financial class. The Aging by Financial insurance carriers according to their assigned financial class. The Aging by Financial Class report could also be used to market your practice to desired financial classes that may not be represented at the desired level within the accounts receivable.
– Note: For the ending A/R total to match the Financial Summaries, this report must be generated through the current date or by date of service. generated through the current date or by date of service.
Aging by Financial Class Report
Leave options blank to view “All”view “All”
Report example
Accounts Receivable Criteria
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Accounts Receivable Module
Billing criteria
Billing Screen displays in Visit Status order
Accounts Receivable or Billing??The choice is yours!
Accounts Receivable
�New Visits not displayed
Billing
�All visit statuses available
�Transactions viewed from spreadsheet
�Must drill into Patient
�Must drill into visit to see transactions
�Statements can be printed �Must drill into Patient demographics to produce a statement
�Statements can be printed for visits selected on spreadsheet
�Must drill into visit to approve or batch a visit
�Total Panel represents
�Mass approvals and batching can be done
�Total Panel represents �Total Panel represents selected Patient Total
�Total Panel represents Spreadsheet Total
Visit Status is the key to follow up!
All of the following are included in the Ins A/R report• In Progress
• Approved• Approved
• Approved Failed
• Batched• Batched
• Filed
• Sent• Sent
• File Succeeded
• File Rejected
• Collections
• User Assigned statuses
Visit Status: IN PROGRESS
The Visit status flips to IN flips to IN
PROGRESS aftercharge entry,
copay posting, or copay posting, or changing the data when it’s NEW.
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Caution Ahead: Things to Remember
IN PROGRESS-
�A Visit can transition to a status of IN PROGRESS�A Visit can transition to a status of IN PROGRESSby an accidental opening of the Visit in the Billing component and clicking OK.
�When a Visit transitions to IN PROGRESS, it separates itself from automatically updating if any changes are made to Patient Information.changes are made to Patient Information.
Visit Status: APPROVED�The Visit has “passed” the 1st CPOPM edits the 1st CPOPM edits and the claim will be “cleanly” printed to paper or is ready for paper or is ready for the 2nd CPOPM edits, “Batching” for electronic “Batching” for electronic submission.
Visit Status: APPROVE FAILED
�The Visit can fail the 1st CPOPM internal edits. These edits are system based and edits. These edits are system based and check to see that a paper claim can be “cleanly” generated. The edits do not check clinical appropriateness (i.e., Dx, CPT clinical appropriateness (i.e., Dx, CPT accuracy). A Visit can fail due to one or all of the following general reasons:
�Patient Information Errors�Patient Information Errors
�Charge Entry Errors
�Administrative Setup Errors
The “Notes” tab of the Visit will contain the The “Notes” tab of the Visit will contain the reasons for the failure.
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Visit Status: APPROVE FAILED
Details of the
APPROVE FAILED
visit will appear
here.
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Visit Status: FILED�The Visit has been printed to paper to the primary, secondary, tertiary, or beyond carriers the status secondary, tertiary, or beyond carriers the status will change from Approved to Filed-Primary, Secondary, Tertiary, or Alternate. Tertiary, or Alternate. The “Claims” tab of the Visit will contain the details of the filing history.filing history.
�Filed-Secondary/Tertiary/Alt: The Visit has “crossed-over” to that carrier.to that carrier.
�The Visit is now waiting for payments and/or adjustments. adjustments.
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Visit Status: BATCHED
This status is seen if:
� filing to a supported clearinghouse.� filing to a supported clearinghouse.
�A Visit has been successfully prepared (passed 1st and 2nd Centricity edits) and “batched” in a file for and 2nd Centricity edits) and “batched” in a file for submission to the clearinghouse
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Visit Status: FILED REJECTED (Internal)
This status can have 2 different definitions: Internal & External
File Rejected – Internal: File Rejected – Internal: This status indicates that the Visit has failed the 2nd CPOPM edits as it attempts to “cleanly” prepare the Visit for electronic submission. These edits are system based and organizes These edits are system based and organizes the data for electronic filing to the clearinghouse. The edit does not check clinical appropriateness (i.e., Dx, CPT accuracy). A Visit can reject due to 1 or all of accuracy). A Visit can reject due to 1 or all of the following general reasons:
�Patient Information Errors�Charge Entry Errors �Administrative Setup Errors �Administrative Setup Errors The “Notes” tab of the Visit will contain the reasons for the failure.
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Visit Status: SENT
Indicates that a claim has been transmitted but reports have not been received.
It is possible these claims NEVER reached the clearinghouse
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Visit Status: FILED SUCCEEDED
�Claim has passed Clearinghouse editsClearinghouse edits
�Claim passed �Claim passed Intermediary or Payer edits
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Visit Status: FILED REJECTED (External)
File Rejected – External: If using a Supported Clearinghouse AND if the Payer’s Reports are capable of being Reports are capable of being processed by CPOPM, the Visit will be rejected whenK
� it does not meet the clearinghouse’s electronic “clean clearinghouse’s electronic “clean claim” edits
AND / OR� it does not meet the payer’s � it does not meet the payer’s electronic “clean claim” edits
The rejection details are located on the “Claims” tab of the Visit or on the “Claims” tab of the Visit or within an EDI Report
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Visit Status: WAITING PATIENT PAYMENT
�The Visit status will transition to Waiting Patient Payment when the entire balance (responsibility) is for the patient. In other words, insurance has paid or adjusted off their other words, insurance has paid or adjusted off their balance.
Visit Status: COLLECTION
�Indicates that this visit has an outstanding balance and been placed in collections.
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Visit Status: OVERPAID
�The Visit status will transition to OVERPAID when all payments to the Visit have exceeded TOTAL Visit balance.
Visit Status: BALANCE FORWARD
�A Visit status of BALANCE FORWARD is achieved when the Balance Forward component is utilized to “bring over” a credit or debit balance
into CPOPM from an outside product or process.into CPOPM from an outside product or process.
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Visit Status: REFILE, REFUND, HOLD
�These are manually transitioned, user-transitioned, user-defined Visit statuses that are typically used according to office according to office policy and procedure. Sometimes they are Sometimes they are used in conjunction with the Visit Owner feature. the Visit Owner feature.
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Work visit statuses regularlyWork visit statuses regularly
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Customize Billing Screen view-User Based
You can control how the columns display on the Accounts Receivable window. Accounts Receivable window.
Specifically, you can hide columns so that they do not display.
You also can adjust the width of each column independently.
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Billing Screen-adjust columns Step 1-Right Click in Title Step 1-Right Click in Title
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Step 2-Select Columns to view
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Step 3-Arrange order of Visible Columns
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Adjust Column Width
To manually resize a column, place the pointer between the columns you want to resize. The pointer changes to a double-arrow which allows you to manually resize either the double-arrow which allows you to manually resize either the column to the left or right of the pointer .
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Right Click on Header to save/sort
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Drill into Visit-Transaction Tab
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Drill into visit-Notes Tab
System generated rejections are
displayed in the notes tab
Examples• Insured ID Missing
• COB information not balanced• COB information not balanced
• Assignment of Benefits not complete
• Referring Physician required
Correction needs to be made• Patient Demographics
• Within the visit• Within the visit
• Administration
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Correspondence Tab
• Click Add to Enter note note
• Note is date stamped with stamped with User name
• Cannot be • Cannot be deleted or modified
• Can be printed
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Claims Tab
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Claims Tab-Upper List Panel
• File Name: The name of the file (only applies to electronically filed claims).
• Filing Method: The name of the filing method.
• Filing Type: The filing type; either Electronic or Paper.• Filing Type: The filing type; either Electronic or Paper.
• Clearinghouse: The clearinghouse to which the file was sent (only applies to electronically filed claims).
• Filed By: The user who filed the claim.• Filed By: The user who filed the claim.
• Filed To: The insurance carrier to which the claim was filed.
• Submission #: A number that uniquely identifies a claim (only applies to electronically filed claims).
• Created By: The user who created the file.
• Date Created: The date the claim was created (only applies to electronically filed claims).
• Procedures Filed: A comma separated list of procedure codes (not CPT Codes) that were filed.
• Amount Filed: The total amount filed.
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Claims tab overview-Paper claims
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Claims Tab overview-electronic claims
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Claims Tab Lower List Box
Displays a list of all report files that have been
generated related to the visitgenerated related to the visit
• Date Received: The date the report file was received from the clearinghouse.
• File Name: the name of the report file.
• DescriptionLists: the visit's claim results.• DescriptionLists: the visit's claim results.
Double Clicking a report file launches a notes
editor, showing the contents of the Description
Field
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Claims Tab overview-electronic claims
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Double clicking on the report will open the response
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Clearinghouse Edits update status
• File Succeeded-File Rejected– If the ticket passes the clearinghouse edits an electronic message is returned that updates the visit status to “File Succeeded”returned that updates the visit status to “File Succeeded”
– Clearinghouse may have payer specific edits by payer
– If the ticket does not pass the clearinghouse edits an electronic –
message is returned that updates visit status to “File Rejected”
Payer Responses update statusPayer Responses update status• File Rejected
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EDI Reports from CEDI
• The reports from Centricity EDI Clearinghouse will • The reports from Centricity EDI Clearinghouse will automatically Process and automatically Archive and will display the information contained in the reports on the Claims tab of each visit. The report filename structure is: Claims tab of each visit. The report filename structure is: IDXRPTIDXRPT########.rpt.
• The reports will update visit statuses to Filed Succeeded or Filed Rejected accordingly.Filed Rejected accordingly.
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EDI Reports from McKesson-aka RelayHealth
• 08_082004– Transmission Report– Auto Archives– Transmission to the Clearinghouse was successful or not– Transmission to the Clearinghouse was successful or not
• XA_082004 and XS_082004– Technical Edit– Auto Processes and Auto Archives– McKesson applies technical edits to the FORMAT of your file, i.e. checking for punctuation,
etcKThe results of this report are stored on the Claims tab of each visit. etcKThe results of this report are stored on the Claims tab of each visit. – If visit was accepted, visit status is changed to File Succeeded. If rejected, visit status is changed
to File Rejected
• CA_082004– Claims Acknowledgement – Claims Acknowledgement – Auto Processes and Auto Archives– McKesson reporting whether or not they will accept each claim, after applying payer edits. The
results of this report are stored on the Claims Tab of each visit.– If visit was accepted, visit status is changed to File Succeeded. If rejected, visit status is changed
to File Rejectedto File Rejected
• EC_082004– Excluded Claims Report– Auto Processes and Auto Archives– For the claims that excluded in the CA report. This report will list the REASON for the Rejection.
The results of this report are stored on the Claims tab of each visit.The results of this report are stored on the Claims tab of each visit.– The visit status is changed to File Rejected
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EDI reports from McKesson cont.
• SF Report– Payer Report
– Auto Processes and Auto Archives
– Payer Response
– Will update visit status to “File Rejected” if Payer rejects– Will update visit status to “File Rejected” if Payer rejects
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Unable to interpret the denial?
• CEDI gives clear explanation plus gives added advantage of the CEDI dashboardadvantage of the CEDI dashboard
• McKesson may be more difficult
www.wpc-edi.com is an excellent resource-add the link to your favorites!
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Washington Publishing Co. website
www.wpc-edi.com
Click here for Code Lists53
Click here for Code Lists
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Claim status codes
Select Claim Status Codes
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Select Claim Status Codes
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Claim status codes
Select List for List for review
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Payer Responses-What to expect!
Electronic Claims
• Initial response from clearinghouse within hours
• Acceptance/Rejection from Payer 24-48 hours
• Payment 7 days• Payment 7 days
• Visit updated automatically
Paper Claims
• Rejections received within 14 days-via mail • Rejections received within 14 days-via mail
• Payment 14 days
• Manually review and document within Centricity• Manually review and document within Centricity
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Questions and Answers
Thank you for attending!
Aida and Karen
We value your feedback
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