Topic

Level

Presenter(s):Jeremy Jones, Director of Training & Implementation RCM

Best Practices for a Healthy AR

200

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They say “an apple a day keeps the doctor

away….”

How many of these “golden apple” suggestions are you following in your practice to keep the AR healthy and strong?

A Healthy Revenue CycleFront Desk• Eligibility• Credit Card Processing• Copay Collection

Charge Entry• Claim Scrubbing• Claim Production• Charge Lag• KAWNC & Encounters With No

Charges

EDI• Claim Submission

A/R Follow Up• Tasking/Worklog• Denial Management

Analysis• Days in A/R• Gross Collection %• Aging Analysis• Scorecard

Front Desk

Real Time Transaction Server (RTS)

EligibilityPatient EligibilityPlan Specifics

Copays & Deductibles

What Does RTS Do For You?

• Insurance eligibility can be checked before the scheduled appointment date/time, during the check-in process or any other appropriate time.

• Eligibility checks can be submitted individually at any time.

• Eligibility information is stored in the patient’s chart so it can be accessed at any time.

Eligibility Check from the Appointment Book

Eligibility Result

More Than Just Eligibility…….

Use the BBP to Automate RTS

• Create an RTS Eligibility Request & Response Job. The job can be set to sweep the appointment book for future appointments. Responses can be tasked in the Worklog.

Tasking Eligibility Responses in Worklog

Is the Juice Worth the Squeeze on RTS?

Ask Yourself

• What are your eligibility denials?

• What are your clearinghouse eligibility denials?

• Do you have authorization denials to due eligibility errors?

• What percentage of your overall encounters are denied for eligibility?

• Use Reason Codes to post denials to quantify (PR28, PR27, etc.)

Credit Card Processing

• Integration with PM using Transfirst or Instamed

• NG Portal Integration

ESP

ESP is an automated method for checking third party coverage on self pay patients.

How Does ESP Work?

The utility allows you to select a group of patient encounters from PM and check for Medicaid, Medicare, and/or Third Party Liability Coverage on them. An encounter note is created for each encounter checked and where coverage is found, an encounter task is created prompting users to bill the encounter to the appropriate party. An Excel spreadsheet is also provided that users may use to update other systems.

For Information: NextGen EDI Team

Charge Entry

ClaimScrubbing

Claim Edit Libraries (CP Tasks)Build as many libraries as necessary to meet your specific payer criteria

• (Medicare, Medicaid, Commercial, Work Comp)

Carriers can share claim edit librariesReview new edits with each releaseUnderstand the “Severity” column as this controls whether the claim will create or not “Warning” (blue errors) – claim still creates “Critical” / “Required” (red errors) – claim will not create

Tidbits from the Claim Edit Library

Customize the claim edit “Help Text” to give the ability to give SPECIFIC instructions to the staff on how to fix claim issues….

Tidbits from the Claim Edit Library

Task Claim Edits….for more granularity in reporting, you can create different task types to group and report on “reasons” for edits.

Tidbits from the Claim Edit Library

Real Time Edits….RTE is an “add on” claim edit program that can scrub your claims via the edit engine. Responses from the engine are fed back into the regular NextGen PM claim edit process.

There are 5 types of edits…

Charge Reports

Charge Lag• Amount of time between the date of service

and the date the charge is entered is the lag. How long is yours? Running a charge report and including the date of service and the create date will allow you to report on the lag.

How to Figure the Lag

Export the charge report to Microsoft® Excel and add a column for the lag.The formula for the lag is a simple mathematical formula of =sum(Crt Dt minus Dt of Svc).

Charge Reports

Kept Appointments With No Charges (KAWNC)

Unbilled Encounters With No Charges

UNBILLED ENCOUNTER REPORT

On Filter 2, the “Chg Count” field must equal “0” to obtain the encounters that have no charges.

EDI

Claim Submission and Statements

Are you letting BBP bill encounters nightly?Are you letting BBP create your EDI files nightly?Are you letting BBP print paper claims?Are you letting your clearinghouse print your claims?Are you letting BBP create your statement file weekly/monthly/daily?Is the statement upload automated?

Accounts ReceivableFollow Up

Tasking….Tasking….

Are You Tasking Outstanding A/R using the Worklog?

Are You Tasking Denials Using the Worklog?

Auto Create Logic in Worklog

Know the difference

between the actions. They look

similar but are different!

Practical Example of Tasking

Here’s what that really means:

Find any encounter that is 31 days old from the last time the encounter was billed and the primary insurance balance on the encounter is between $.01 and $999,999 for any payer that has a financial class of Medicare primary and the encounter has either an unbilled, rebilled, or billed status.

Suggestions for Tasking

Create task names that are meaningful (i.e. Medicare Follow-Up, Blue Cross Follow-Up) – remember these can be reported.

Task your aging by financial class. Use Payer Override to re-direct specific payers to a different user/workgroup.

Task reasonable follow-up timeframes • (Example: Medicare pays in 14 days – so set a reasonable expectation

to receive the payment and have it posted)

Monitor the tasks created by running task reports to ensure no “oops”. Be sure the auto-completion reasons are setup/working.

Work with end users to design the Worklog manager to meet their needs.

Tasking Denials from an EOB

A denial task can be created automatically based upon the reason code associated with the denial.

• Ensure your reason code library is updated with the correct remark codes.

• “Normalize” the verbiage of the reason code if necessary.• Make sure the reason codes are set correctly to either “skip” or

“not skip” adjustments

Are Your Reason Codes Set?

Normalize description

Set ERA Adjustments

Associate reason code with a category

Set the Auto Create in Tasking…

Based upon the denial task type, the appropriate reason codes or reason code subgroupings are attached.

Analysis

Aging Analysis

Which Report is best?

Do you know the difference between the aging reports?

Aging Analysis

Aging Analysis ages the receivable and reports by

financial class.

Aging Analysis

Insurance Aging Analysis ages the receivable by the

responsible payer.

Aging Analysis

Scenario: Patient Patty Pickles presents for an appointment and has forgotten her $25 copayment. She sees the provider and a 99213 for $125 is billed to her primary insurance, ABC Insurance.

Aging Analysis ReportThe entire balance of $125 would be reported under the financial class of “ABC Insurance”

Insurance Aging Analysis ReportA balance of $100 would be listed under the responsibility of the “ABC Insurance” and a separate balance of $25 would be listed under patient responsibility

Benchmarks

Days in A/R

Gross Collection %

Denials

Tasking

Wee

kly

Sco

reca

rd

Sample ScoreCard

Key Indicators/Scorecard 9/21/2014 9/28/2014 10/5/2014

Charges MTD $1,658,326.23 $1,761,785.47 $197,464.23

Payments MTD $725,609.51 $877,730.97 $170,880.77

Cash Projection for the Month $1,024,674,.32 $971,697.11 $1,655,418.30

Zero Pays from Previous Week

Elig 13 13 3

Coding 13 16 6

Auth 1 1 1

Provider ID Denials/Credentialing 0 0 0

Encounters with No Charges YTD Prior month end 0 2 89

Encounters with No charges Current MTD 112 275 49

Total AR from Create Date $2,207,083.66 $1,839,477.17 $1,980,156.55

AR over 90 from Create Date $172,560.00 $163,500.00 $175,880.00

Percentage of AR over 90 7.82% 8.89% 8.88%

Patient AR over 90 days from date of pt resp $95,000.00 $85,220.00 $78,598.00

Unbilled for credentialing $283.00 $11,315.00 $0.00

% of Overdue Not Started Tasks (over 5 days) 6.00% 8.00% 7.00%

% of Overdue In Progress Tasks (over 14 days) 9.00% 5.50% 6.50%Payers of Concern/Projects

UHC TakebacksKnown Current Issues:

Dr Smith Revalidation Medicare ERA Delays

Weekly Scorecard SuggestionsCharges MTD Monthly Changes in AR Monthly changes in AR - filter 1 = Month to date

Payments MTD Monthly Changes in AR Monthly changes in AR - filter 1 = Month to date

Cash Projection for the Month Daily - By Line Item - Payments Average daily posted amt times the number of working days (posted in Nextgen)

Average daily deposits times the number of working days (from posting log)

Zero Pays from Previous Week 0 pays From Last Week by Subgroup

Elig Daily - By Line Item - Reason Code - Payments

Coding Daily - By Line Item - Reason Code - Payments

Auth Daily - By Line Item - Reason Code - Payments

Provider ID Denials/Credentialing Daily - By Line Item - Reason Code - Payments

Encounters with No Charges YTD Prior month end Encounter Listing Enc listing filter 1 = custom 1/1/14 - 4/30/14

Encounters with No charges Current MTD Encounter Listing Enc listing filter 1 = month to date; enc age greater than 3 days

Total AR from Create Date Insurance Aging Analysis Ins aging filter 1 = process date of today; aging dates Create Date *Less Credits

AR over 90 from Create Date Insurance Aging Analysis Ins aging filter 1 = process date of today; aging dates Create Date *Less Credits

Percentage of AR over 90 Insurance Aging Analysis AR over 90/total AR *Less Credits

Patient AR over 90 days from date of pt resp Insurance Aging Analysis Ins aging filter 1 = process date of today; aging dates Dt of Pt Resp *Less Credits

Unbilled for credentialing

Example of Trending Report using data from standard NextGen Reports

Monthly Changes in A/R

Aging Report / Bad Debt Status Only

Transaction Report – Bad Debt TxsUnapplied Report

These lines are simple Excel formulas

Excel FormulasNet A/R

• Ending AR – Bad Debt A/R – UnappliedDays in A/R

• (Net AR/Charges) * Days In MonthCharges Per Day

• Charges/Days In MonthPayments Per Day

• Payments/Days In MonthGross Collection %

• (Payments/Charges) *-1Adjusted Collection %

• Payments/(Charges + Adjustments)

Any Questions?

Jeremy Jonesjjones@rcm.nextgen.com

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