Office Manager: Using Workflow Organization Basis · Unity Healthcare, LLC –Workflow Organization...

Office Manager:

Using Workflow Organization Basis

AUGUST 9, 2016

ACE 2016

AUGUST 9 – 11, 2016

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 3

Introductions

• Dana Corkern, Solution Manager

for Allscripts PM

• Have been with Allscripts for 12

years

• Prior to joining the Allscripts team,

worked for a several Allscripts

clients for 9 years.


Introductions

• Unity Healthcare, LLC has several locations around the Lafayette, Indiana area and uses

Touchworks EHR, Allscripts Practice Management, Payerpath and Follow My Health

• Unity has been an Allscripts client since 2001. Prior to implementing Allscripts Practice

Management, they were a long time Allscripts Vision client

• Tanya Richardson is a Application Systems Manager for the Allscripts applications

• Heather Dawson is the Central Billing Office Manager and manages 33 employees

• Unity Healthcare has about 200 providers

• Their organization employs over 665 talented personnel


Unity Healthcare Office Manager Overview• Unity has 5 production databases

• Largest database has 55 departments

• Total average claims moving through Office Manager

– daily 31,000 claims

• Average days in A/R - 31


Unity Healthcare Philosophy

• Unity Healthcare treats each

practice/client individually

• Each collector are assigned several

practices


Unity Healthcare Collector Breakdown

– Self Pay Collection representatives = 4

– Insurance Follow-up representatives = 17

– Refund Specialist = 3

– Payment Posters = 6.5 (no online bill pay at this

time)

– Reimbursement Specialist = 1

– Claims/Statement Specialist = 1

– Scanner = .5

What is Workflow Organization Basis?


Simply put…• It is the hierarchical definition of how you work your pending claims and unpaid

claims

– After you define a basis, the following occurs:

• The select records that correspond to your basis criteria are disabled in Work Queue

Maintenance

• Operators are assigned to work queues using your defined basis criteria in Workflow

Organization Maintenance

• Vouchers are assessed by the system using the criteria selected for the WOM and WQM

records and assigned to a queue

• IMPORTANT NOTE: a voucher can only be assigned to one queue at a time and this is

done based on the order of priority set in WOM


Unity Healthcare, LLC – Workflow Organization Basis Setup

• First the system looks

for

Practice/Department

specifications

• Second the system looks

for Insurance Reporting

Class specifications

• Last the system looks

for any Actual Provider

specifications

Understanding Setup: Workflow

Organization Basis - Pending Claims


Pending Claims Management


Pending Claims – Held Vouchers

• Create all the Held

Voucher reasons in

HVM• Possible to filter by:

– Providers

– Departments or

Practice

– Insurance Carriers

– Locations

– Hold Status


Held Voucher Reason Setup

• F9 and access HVM

• If Department Security is

enabled, Held Voucher Reason’s

can be created for

Dept/Practices


Held Voucher Reason Setup


Placing Vouchers On Hold Manually

• TRA > Edits Tab

• What do you want to hold the

voucher?

• Select a Held Voucher Reason


Pending Claims Failed Validations(Electronic & Paper)


Workflow Organization Maintenance • Management Category – Pending

Claims

• You can filter and create WOM’s

based on basis selected

• Add Work Queues for the WOM

• Attach the operators


Office Manager – Pending Claims Management

• Basis is by Department/Practice

• Sorted by queues:

– Pending Claims – Electronic

– Pending claims – Office Held

Vouchers

– Pending claims - Paper

Understanding Setup: Workflow

Organization Basis - Unpaid Claims


Unpaid Claims Management


Unity Healthcare – Unpaid Claims Setup• Work each Department/Practice independently

– Practice LOC – large practice for Unity Healthcare

• 3 classifications used per Department/Practice:

– Office

– Denials

– INS CBO

• The Office items are pushed to the office to be worked by

practice staff

• Denials and INS CBO are worked by Central Billing Office staff

• Client breaks unpaid/un-responded claims by carrier groupings:

– Commercial

– Government (Medicare, Medicaid, Tricare, etc.)


WQM – Office Queue


Office Work Queue – Filtered by Claim Note Types

• Claim Notes are

added by Central

Billing Office staff

to drive claim onto

the Office Work

Queue


Note Type Maintenance Setup


WQM – Denial Queue Setup


Denial Work Queue – Filtered by Reimbursement Comments


Reimbursement Comment Category Maintenance


Reimbursement Comments Maintenance Setup

• F9 > RCM

• Review the

Reimbursement

Comments and

make sure the

category is set

correctly


WQM – INS CBO Queue


Office Manager Queues

Unpaid

Claims

Pending

Claims

Queues sorted

by

Practice/Dept

due to Basis

Office Manager – All Setup… Now

What?


Denial and INS CBO Work QueuesFollow-up staff process

Claim Notes are added by Central

Billing Office staff

Notes allow for productivity tracking

Notes add routine messages to claim

without manual typing

Notes guide follow-up staff on

appropriate follow-up days to

assign based on the note

Indicated by parenthesis behind

the note description


Office Manager – Grouping Option

• Drag the Payor to the

column header to group

by

• Group by:

– Payor

– Service Date

– Patient

– Provider

– Age

– Follow-up date

– Etc…


Office Manager – Grouping Option


Unity Office Manager – Work Queue Example

• Can be sorted by column headers

– F/U Date helps keep claims worked in appropriate time frames

– Payor column allows you to see any trending with outstanding claims

– Balance allows claims to be worked by outstanding dollar amount for high dollar claims


Process for sending claim to office

• Select a Voucher / Claim from Unpaid Claims Management

• Collector right clicks on voucher/claim and selects Claim Notes

• Add ADDOFF claim note to drive the claim to the Office queue. Collector enters note with the

required information


Continued Process…

• Office staff has 7 days to respond

• After providing the Requested information or making the necessary Corrections, the office staff

Right clicks and adds the Note Type = *Claim Note and changes the follow-up date to Today

• This process will push the claim back to the CBO’s queues to be reviewed and processed

Office Manager – Productivity

Reporting


Productivity Reporting Crystal Reports

• Report pulls all claims notes

added for the previous week for

each Central Billing Office follow-

up staff member

• Summary (shown) or detailed

report can be reviewed for

supervisory evaluation


Questions?

41

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