Be the King or Queen of Denials – Denials Management in MEDITECH 6.0 Debbie Meredith

2. Be the King or Queen of Denials – Denials Management in MEDITECH 6.0 Debbie Meredith

3. Introduction • Today we’ll talk about how to set up the Denial Management Dictionary • Denial Management is a tool that can be used by an organization for meeting goals for AR Days and Business Office objectives cross the enterprise. • When we get finished you’ll have a good understanding of how Denial Management is used which can save you hours of manual efforts and re-work.

4. Speaker Introduction • Debbie Meredith -- Senior Analyst • I have been in Healthcare for over 19 years and the past 8 in the Revenue Cycle implementations and optimizations • I currently am a BAR Analyst at a multi-facility healthcare organization where they are standardizing and converting 31 hospitals to MEDITECH 6.0 and a common EHR • I have converted patient financials for large and small hospitals in both multi-facility and stand-alone facilities.

5. Introductions What is Denial Management? Agenda Setting up Denial Mgmt Dictionaries Closing Remarks Questions and Discussion

6. Denial Management How many of you are struggling with Denial Management in your current environment?

7. Denial Management • With proper setup you can manage your healthcare organization’s remittance advice codes that are received in response to your claim submissions. • The new Denial Management Desktop in v6.0 helps sort denial claims, identify actions, assign follow up and enter denial notes. • This reduces AR, eliminates handling the same claim multiple times and designates responsibility for resolution of the denial.

8. Introductions What is Denial Management? Agenda Setting up Denial Mgmt Dictionaries Closing Remarks Questions and Discussion

9. Remit CodeDenial Status Dictionary • Use this routine to define denial statuses of remittance advice codes. • Each remittance advice code can have a status of: • Opened • Appealed • Closed • Further define each status into smaller subsets, to uniquely identify the current state of remittance advice codes on a worklist.

10. Remit CodeDenial Status Dictionary • The worklist within the Denial Desktop includes a Status column. You can filter the worklist by Denial Status.

11. Remit CodeDenial Status Dictionary • For example, create a Denial Status called OPEN/L and associate it with a status of O (for Open), to signify that the remittance advice codes is open and that a letter regarding the code has been queued.

12. Denial Department Dictionary • Use this routine to define the group or department responsible for resolving the issue or issues that caused the denied remittance advice codes. • Denial Departments are linked to the Remit Reason Dictionary. • Both are can be used for reporting purposes

13. Remit Reason Dictionary Use the Remit Reason Dictionary routine to define the explanation or cause of a remittance advice code. One denial department can be defined for each Remit Reason entry.

14. Remit Reason Dictionary For example, define an entry called ABS CODE to classify remittance codes related to coding errors that caused a charge to be rejected by the payer. In this case, create a Denial Department called ABS that will be responsible for resolving coding errors.

15. Remittance Advice Code Dictionary Use the Remittance Advice Code Dictionary to define remittance advice codes. Remittance advice codes from insurance companies or intermediaries help health care organizations manage insurance companies' responses to their claim submissions.

16. Remittance Advice Code Dictionary – General Screen The General screen allows you define the mnemonic for the remittance advice code, and the insurance carriers associated with that code

17. Remittance Advice Code Dictionary – Codes Screen Use this screen of the Remittance Advice Code Dictionary to define a schedule of effective dates for remittance advice codes. For every effective date that is specified (usually the date when codes are updated), a multiple code type can be assigned. One or more remittance advice codes can be further associated to a code type.

18. Remittance Advice Code Dictionary – Code Screen Define each individual remittance advice code with the following information: Denial Type Whether to send code to the ABS application Remit Reason Where to transfer leftover amount (for line-item remittance only) Letter to be queued Name Canned text Description

19. Remittance Advice Code Dictionary – Code Screen Each time an effective date is added, the system adds the new date below the last effective date in the lookup. Fatal, Non-Fatal, and Informational remittance advice codes appear on the denial user's worklist. No Action remittance advice codes do not appear on a worklist, but any remittance codes with the same UCRN will appear on the RA Code Data screen, and the Denial User can see No Action codes for that same UCRN on that screen. Adding Remit Reason value to a remittance advice code allows you to track the denial departments responsible for processing that denial.

20. Remittance Advice Code Dictionary – User Screen Use this screen of the Remittance Advice Code Dictionary to define criteria in which specific users are responsible for specific remittance advice codes.

21. Remittance Advice Code Dictionary – User Screen Assign remittance advice codes to users in the following manner: assign denial codes based on a range of insurance carriers assign denial codes based on effective date/code type/code combinations assign default users, in case other settings on this screen are not applicable If all of the denial codes to go to one person, only define the default user on this screen and leave the rest of the fields on this screen blank. NOTE: This screen does allow for greater specificity to the user settings. The only options of assigning users is by an effective date/code type/code schedule or by insurance.

22. Remittance Advice Code Dictionary – User Screen Sequence of Evaluating Criteria for Remittance Code Assignments The three sections on the Users screen also represent the hierarchy of values that the system uses when assigning denial codes to users.

23. Remittance Advice Code Dictionary – User Screen Since the bottom section contains very specific criteria, the system uses the bottom section first, then the insurance criteria on the middle section, then the most general criteria on the top section.

24. First Criteria – Effective Date/Code Type/Code Schedule When a batch with remittance advice codes is posted, the system looks at the effective date of the remittance code as the first step. The effective date is based on the code's transaction service date from the batch.

25. Second Criteria - Insurance • Assign remittance codes by insurance or a range of insurances if further assignment of codes is needed; and/or create an alpha split within that grouping.

26. Third Criteria – Default User If neither the first criteria nor second criteria does not apply, the user in the Default User field will be assigned the denial codes.

27. Introductions What is Denial Management? Agenda Setting up Denial Mgmt Dictionaries Closing Remarks Questions and Discussion

28. Closing Remarks • Now that you have been through the process of setting up the denial dictionaries you can see the setup time is worth the payoff of being able to evaluate your payors and the denials they are sending. • Some key points to remember: • With the Denial Management you can trend the total number and dollar value of remittance codes that have been denied, open, appealed and that have been recovered • You can organize your worklists and organize the workload of the denial user to gauge performance and shift resources as necessary

29. Questions and Discussion Thank You! Questions/Comments: Debbie Meredith (O) 513 564 0909 Booth #509 Deborah.meredith@ctghs.com