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Revenue360 for QES version 13. Nick Davis & Jennifer Estes: Tuesday 8/20, 9-10 AM. Agenda. Revenue360 for QES Overview & Demo Revenue360 Platform Overview Address Validation Demographic Validation Insurance Eligibility Verification Pricing Estimation Benefits & Results Q & A.
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Revenue360 for QES version 13 Nick Davis & Jennifer Estes: Tuesday 8/20, 9-10 AM
Agenda • Revenue360 for QES Overview & Demo • Revenue360 Platform Overview • Address Validation • Demographic Validation • Insurance Eligibility Verification • Pricing Estimation • Benefits &Results • Q & A
The Challenge… It takes me 2 years to train a registrar to learn all they need to know … …but they leave after 6 months! Quote from a Director of Registration for an Ohio hospital
Get it Right the First Time! AUTOMATES MANUAL PROCESSES - IMPROVES EFFICIENCY - REDUCES COSTS AND BAD DEBT - INCREASES PRE-SERVICE CASH COLLECTIONS
The right information To the right person At the right time In the right format Just In Time Knowledge Distribution Computerized guidance ensures your best practice process is followed – preventing many errors that lead to denials and rework
QES-Revenue360® Address Validation • Powered by USPS®Address Matching System & Revenue360 Intelligent Guidance • Integrated directly with QES (auto or manual) • Includes standalone AV option • Web-based, thin client response viewer • Uses facility defined business rules to: • Verify if a Patient / Guarantor address is a valid existing address • Identify unknown or incomplete addresses for Demographic Validation • Update Patient / Guarantor address to USPS standard
Why Validate Identity? • Enhance patient identity management • Improve address input accuracy • Increase Self Pay collections • Decrease accounts sent to collections • Correct known bad addresses • Provide better patient care and outreach • Increase patient satisfaction • Red Flags regulation compliance • fraud detection
Red Flags Requirements • The FTC, the federal bank regulatory agencies, and the NCUA have issued regulations (the Red Flags Rules) requiring financial institutions and creditors to develop and implement written identity theft prevention programs, as part of the Fair and Accurate Credit Transactions (FACT) Act of 2003. • The programs must provide for the identification, detection, and response to patterns, practices, or specific activities – known as “red flags” – that could indicate identity theft.
Red Flags Requirements • Typesof Red Flags • Alerts, notifications, or warnings from a consumer reporting agency; • Suspicious documents- drivers license, etc. • Suspicious personally identifying information, such as a suspicious address; • Unusual use of – or suspicious activity relating to – a covered account; • Notices from customers, victims of identity theft, law enforcement authorities, or other businesses about possible identity theft in connection with covered accounts.
Revenue360®Demographic Validation • Powered by USPS® AMS, Lexis Nexis® & Revenue360 Intelligent Guidance • Integrated directly with QES (manual) • Includes standalone DV option • Web-based, thin client response viewer • Uses facility defined business rules to: • Confirm Patient/Guarantor address & demographic information entered into QES • Identify and correct invalid Patient/Guarantor address & demographic information • Locate unknown Patient/Guarantor address & demographic information
Benefits of Address & Demographic Validation • Enhanced Eligibility match – higher clean claims submission • Seamless Integration – no disruption to standard process flow • Increased self-pay collection • Reduced third party collection and write-off expense • Decreased Cost associated with returned mail • Improved compliancy • HIPAA • Red Flags Rule
National Registration Errors Most Common Errors
Why Verify Insurance Eligibility? • To get the claim paid • Make sure claim goes out clean • Reduce denials • Increase collections from payer and patient • Identify critical information • Is there benefit coverage for the service • Copy, Deductible & Coinsurance responsibility • Will pre-authorization be required • Goal • Maximize payment for services • Increase cash, lower AR Days, reduce rework & bad debt
QES-Revenue360® Eligibility Verification The Response Summary simplifies interpreting benefit coverage and discrepancies of what was returned from the insurance company
Eligibility – Response Summary Only displays information returned from payer that is different than what you sent in the 270 request Intelligent Guidance – notifies staff that insurance coverage was found for this self-pay patient. Action instructions can be added.
Eligibility – Full Response The full 271 response is always just a tab away so that all benefit coverage information is easily accessible Full Response is always available for reference now – or later in Billing Office
Eligibility – Out of Pocket Expenses Co-insurance, Co-Pay and Deductible Tab simplifies identification and collection of patient out-of-pocket expenses and can easily be exported to the Pricing Estimator
Eligibility – Worklists Eligibility Worklists help manage workflow and find historical transactions
Eligibility – Standalone Verification Verify benefit coverage for patients that show up in the ED, clinics, physician offices, radiology or anywhere they walk-in to your facilities Eligibility can be verified anywhere throughout the hospital outside of QES. Patient account set up is not required.
Can you communicate the patients true out-of-pocket cost? • What will their insurance cover? • How much is the procedure? • What is their copay, deductible and coinsurance responsibility? • Can you provide enough information to be credible with the patient? • Is your staff capable of asking for the payment in a consistent patient friendly manner. • What happens if the patient cannot pay?
Calculate patient total out-of-pocket cost Three major components: • Charges (Adjudicated Claims) • Eligibility and Benefit Coverage • Insurance Contracts Total Estimated Amount: $759.72 Estimated Patient Amount: $389.07 Total Allowable Amount: $445.33
Requesting a Price Estimation When pricing estimate can be provided, “Send to Pricing Estimator” button sends the eligibility response to the Pricing Estimation Module
Auto-populates Patient Visit Information Pricing Estimation auto-populates facility and patient information from eligibility module
Select Procedure (CPT / ICD) Codes CPT Codes can be entered or staff can be guided to the correct code through incremental text search
Auto-populates Benefit Information from the Eligibility Response Pricing Estimator auto-populates with the correct service co-pay, co-insurance and deductible from the Eligibility Response
Simplified Accurate Estimates Patient total out-of-pocket is instantly calculated and notes can be entered to be added to the payment letter
Customized Letters Customized, professional estimate letters can be printed, emailed, faxed and include your healthcare system logo – payment remittance options can even be included to assist with front-end collection efforts
Benefits of the Revenue360 Platform • Guide your staff to make the right decisions for every patient, every time… • Error reduction – prevents common errors • Enforces compliance to your process • Allows staff to focus on patients instead of policies • Improves job performance, satisfaction & retention • Getting it right the 1st time gets the hospital paid faster! • Make sure claims go out clean - reduce denials • Identify patients that need financial help from those who can pay • Maximize collections from both payer and patient • Increase cash, lower AR Days, reduce rework & bad debt
Actual Customer Results BEFOREAFTER Total patient revenue Increased point-of-service revenue Decreased AR Days
Questions & Answers THANK YOU! For more information go to: www.revenue360.net
Daily Session Evaluation Sheet Giveaway • Don’t forget to complete your Daily Session Evaluation Sheet • Return the completed form to the Registration Desk at the end of each day to become eligible for: • $100 Gift Card daily drawings You are in Session CXX
