Utilizing managed care claims data effectively for improved revenue
Download
1 / 8

Utilizing Managed Care Claims Data Effectively for Improved Revenue - PowerPoint PPT Presentation


  • 106 Views
  • Uploaded on
  • Presentation posted in: General

Managed Care Boot Camp. Utilizing Managed Care Claims Data Effectively for Improved Revenue. Presented By: Kerry Elledge Quadax, Executive EDI 5/16/2013. Managed Care Boot Camp. Revenue cycle systems & services Exclusively serving the Healthcare market

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha

Download Presentation

Utilizing Managed Care Claims Data Effectively for Improved Revenue

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Utilizing managed care claims data effectively for improved revenue

Managed Care Boot Camp

Utilizing Managed Care Claims Data Effectively for Improved Revenue

Presented By:

Kerry Elledge

Quadax, Executive EDI

5/16/2013


Managed care boot camp

Managed Care Boot Camp

  • Revenue cycle systems & services

  • Exclusively serving the Healthcare market

  • Privately held company, 550+ employees

  • 800+ clients in over 33 states

    ~ 766 EDI Services clients (7 States)

    ~ 50 A/R Services clients

  • Client retention of 95%+ has been driven through true partnerships

. .

. .

..

..


Managed care boot camp1

Managed Care Boot Camp

  • Claim Drop – From Host System

  • Scrub-A-Dub Dub:

    • Edits: Payer, NCD, LDC, CCI, MUE, OCE

    • Edits: Custom

. .

. .

..

..


Managed care boot camp2

Managed Care Boot Camp

  • Auto Release (Clean) or Correct and Release

  • Off to the Payer – Accept or Reject

  • Into the Payers Adjudication System – To Pay or Not to Pay…That is the ?

  • Return 835/Remittance

. .

. .

..

..


Managed care boot camp3

Managed Care Boot Camp

  • Medicare No-Pay Claims

    • HIC #

    • Condition Code

  • Medicare/Medicaid Edits applied to Managed Care Plans

. .

. .

..

..


Managed care boot camp4

Managed Care Boot Camp

  • Eligibility Edits – Medicare

    • Check various eligibility information

      • HMO Managed Care/PPO (Includes Plan ID and Name)

      • Enrolled in Hospice

      • Skilled Nursing Facility Care

      • Part A/Part B Coverage

  • Reporting Specific to Managed Care – Segmentation

    • Claims/Remittance/Denials (Get 835)

. .

. .

..

..


Managed care boot camp5

Managed Care Boot Camp

  • Claims are processed more quickly - You receive payment faster

  • You’ll be aware of denials sooner with greater opportunity to reverse

  • Key savings opportunities

    • No longer paying postage

    • No longer have to pay for the forms

    • Save employee time of manually creating secondaries

    • Streamlined follow-up

. .

. .

..

..


Managed care boot camp6

Managed Care Boot Camp

  • 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

..

..

..


ad
  • Login