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Today’s Revenue Cycle Process: Helping You Sleep Better at Night

Increase Cash Flow….Drive Revenue Cycle Efficiencies….Reduce Bad Debt …. Today’s Revenue Cycle Process: Helping You Sleep Better at Night. Presentation to N.W. Ohio HFMA August 29, 2012 Jim McCauley, Vice President, EDI Services. Xpeditor Xtensions. Do More!. . . . .

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Today’s Revenue Cycle Process: Helping You Sleep Better at Night

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  1. Increase Cash Flow….Drive Revenue Cycle Efficiencies….Reduce Bad Debt …. Today’s Revenue Cycle Process: Helping You Sleep Better at Night Presentation to N.W. Ohio HFMA August 29, 2012 Jim McCauley, Vice President, EDI Services

  2. Xpeditor Xtensions Do More! .. ..

  3. Xpeditor Xtensions .. ..

  4. Claims ManagementX

  5. Claims ManagementX • Powerful edit engine • Standard: LCD, NCD, CCI, OCE, MUE, RAC edits • Custom (client defined): written by Quadax developers, usually 48-hour turnaround (testing may require additional time) • Client-written: developed through the XpressBiller utility, an easy-to-use wizard .. .. ..

  6. Claims ManagementX Comprehensive reporting enables you to manage your claims, not just transmit them • Every edit available for analysis Eliminate manual intervention & compilation of data .. ..

  7. Remittance ManagementX

  8. Remittance ManagementX • Full Integration • Full Support • Management Tools • Better Data (including posting files & comment records) .. .. ..

  9. Denial ManagementX

  10. Denial ManagementX • Effective denial management strategy • Identify, Classify, Quantify • Manage Denial Follow-Up • Prevent Denials Through Process Improvement • Develop Effective Reporting Where do denials come from? Any and all points in the revenue cycle .. .. ..

  11. DMXBR : Basic Reporting Anything that is delaying payment to your organization is ripe with data for process improvement. Pre-mapped to standard error/denial categories Approximately 250 ANSI codes Approximately 13,000 codes Approximately 2,100 codes .. .. ..

  12. DMXWF: Workflow • Decrease Overall A/R • Quickly identify both full and partial denials and route them to users with best skill sets to work them • Provide easy access to key denial source documents for follow-up users • Decrease Costs to Work Denials • Improve staff efficiency in working denials by setting up default orders within worklists to group similar types denials • Increase Visibility of Denial Aging Inventory • Utilize management dashboard reporting to target key denial inventory issues .. .. ..

  13. DMX: A Case Study Note: Payments reflect Charges associated with Paid Claims (not actual payments); Denials Reflect Charges associated with Denied Claims/Lines. Claim Status 22 has been excluded and denials with prior payment have been excluded. Duplicate Example (18/B13/97). FYI – 96 has been included under non-covered service. .. ..

  14. EligibilityX

  15. EligibilityX • Verify that an individual has valid Insurance coverage • Validate demographic information to match spelling, etc. on file with payer • Determine the level of coverage for service type • Determine Co-Pay, Deductible, other Insurance, etc. Tip: Do a batch eligibility check on self-pay to ensure patient was not eligible for Medicaid on date of service .. .. .. ..

  16. EligibilityX • Real Time (any point of entrance) • Automated (specified claims, self-pay, Medicaid) • Batch (pre-registration, self-pay, collection accounts) • Back End (rejected, denied) .. ..

  17. EligibilityX .. ..

  18. Claim StatusX

  19. Claim StatusX • There are always exceptions • Do you know what they are? • Do you know why they are? • Is there a need for an automated solution to help manage and report on these claim delays? .. .. ..

  20. Claim StatusX • HIPAA-mandated 276/277 still coming into its own • Perform transactions manually, as needed • Automated Claim Status responses can be exported to the host system. Either source 277 can be provided or a customized comment file. .. .. ..

  21. Automated Claim Status Transactions • Eliminate the need for sifting through reports • Eliminate wasted time on the phone with payers • Eliminate keying into payer web sites • Rely on automated processes to catch every outstanding (unpaid) claim • Be assured that no claims have fallen through the cracks • Improve efficiency & Days in A/R with faster intervention .. .. ..

  22. Audit ControlX

  23. Audit ControlX • Full suite of products to manage every kind of audit: RAC, MIC, etc. • Preventive Edits • Audit ControlX Axis • DataXtract • Data Mining • Also available from our partners, Human Arc and EHR: hands-on appeals management .. ..

  24. Audit ControlX Axis • A Secure, web-based, hosted application • Gives everyone on your RAC team easy access • Axis™ for workflow, tracking, & reporting • Integration with • AHA RACTrac • Human Arc • EHR .. ..

  25. Medicare ConnectionX

  26. Medicare ConnectionX • Medicare ConnectionX • Interactivity with FISS for enhanced Medicare claims control Faster Reimbursement Streamlined Workflow Better Reporting .. ..

  27. Questions .. .. ..

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