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Revenue360 for QES version 13

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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. - PowerPoint PPT Presentation

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Revenue360 for QES version 13Nick Davis & Jennifer Estes: Tuesday 8/20, 9-10 AM

AgendaRevenue360 for QES Overview & Demo

Revenue360 Platform OverviewAddress ValidationDemographic ValidationInsurance Eligibility Verification Pricing Estimation

Benefits & Results

Q & A


Whats the most complex job in healthcare?Copyright 2011 NTT DATA Corporation3Quote from a Director of Registration for an Ohio hospitalIt takes me 2 years to train a registrar to learn all they need to know

but they leave after 6 months!The Challenge4

AUTOMATES MANUAL PROCESSES - IMPROVES EFFICIENCY - REDUCES COSTS AND BAD DEBT - INCREASES PRE-SERVICE CASH COLLECTIONSGet it Right the First Time!The right informationTo the right personAt the right timeIn the right format

Computerized guidance ensures your best practice process is followed preventing many errors that lead to denials and reworkJust In Time Knowledge Distribution6QES-Revenue360 Address Validation

QES-Revenue360 Address ValidationPowered by USPS Address Matching System & Revenue360 Intelligent GuidanceIntegrated directly with QES (auto or manual)Includes standalone AV optionWeb-based, thin client response viewer

Uses facility defined business rules to:Verify if a Patient / Guarantor address is a valid existing addressIdentify unknown or incomplete addresses for Demographic ValidationUpdate Patient / Guarantor address to USPS standardQES-Revenue360 Address ValidationDemonstration

QES-Revenue360 Address Validation

QES-Revenue360 Demographic Validation

Why Validate Identity?Enhance patient identity managementImprove address input accuracyIncrease Self Pay collectionsDecrease accounts sent to collectionsCorrect known bad addressesProvide better patient care and outreachIncrease patient satisfactionRed Flags regulation compliance fraud detectionRed Flags RequirementsThe 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.Types of Red FlagsAlerts, 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.Red Flags RequirementsRevenue360 Demographic ValidationPowered by USPS AMS, Lexis Nexis & Revenue360 Intelligent GuidanceIntegrated directly with QES (manual)Includes standalone DV optionWeb-based, thin client response viewerUses facility defined business rules to:Confirm Patient/Guarantor address & demographic information entered into QESIdentify and correct invalid Patient/Guarantor address & demographic informationLocate unknown Patient/Guarantor address & demographic informationQES-Revenue360 Demographic ValidationDemonstration

QES-Revenue360 Demographic Validation

Enhanced Eligibility match higher clean claims submissionSeamless Integration no disruption to standard process flowIncreased self-pay collectionReduced third party collection and write-off expenseDecreased Cost associated with returned mailImproved compliancyHIPAARed Flags Rule

Benefits of Address & Demographic ValidationQES-Revenue360 Eligibility VerificationNational Registration ErrorsMost Common Errors21% related to invalid member ID18% Invalid group #16% No referral15% No pre-authorization12% Member was ineligible11% The service not covered 9% They had the wrong (on no) diagnosis code

Copyright 2011 NTT DATA Corporation20Why Verify Insurance Eligibility?To get the claim paidMake sure claim goes out cleanReduce denialsIncrease collections from payer and patientIdentify critical informationIs there benefit coverage for the serviceCopy, Deductible & Coinsurance responsibilityWill pre-authorization be requiredGoalMaximize payment for servicesIncrease cash, lower AR Days, reduce rework & bad debtQES-Revenue360 Eligibility VerificationDemonstration

QES-Revenue360 Eligibility Verification

The Response Summary simplifies interpreting benefit coverage and discrepancies of what was returned from the insurance company

24Intelligent Guidance notifies staff that insurance coverage was found for this self-pay patient. Action instructions can be added.Only displays information returned from payer that is different than what you sent in the 270 requestEligibility Response SummaryCopyright 2011 NTT DATA Corporation24

Full Response is always available for reference now or later in Billing OfficeThe full 271 response is always just a tab away so that all benefit coverage information is easily accessibleEligibility Full ResponseEligibility 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

27Eligibility Worklists help manage workflow and find historical transactionsEligibility WorklistsCopyright 2011 NTT DATA Corporation27

28Eligibility can be verified anywhere throughout the hospital outside of QES. Patient account set up is not required.Verify benefit coverage for patients that show up in the ED, clinics, physician offices, radiology or anywhere they walk-in to your facilitiesEligibility Standalone VerificationCopyright 2011 NTT DATA Corporation28QES-Revenue360 Pricing EstimationWhat 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?Can you communicate the patients true out-of-pocket cost?30Three major components:Charges (Adjudicated Claims)Eligibility and Benefit CoverageInsurance ContractsTotal Estimated Amount:$759.72Estimated Patient Amount: $389.07Total Allowable Amount:$445.33Calculate patient total out-of-pocket cost31QES-Revenue360 Pricing Estimation Demonstration

33When pricing estimate can be provided, Send to Pricing Estimator button sends the eligibility response to the Pricing Estimation ModuleRequesting a Price EstimationCopyright 2011 NTT DATA Corporation33

Pricing Estimation auto-populates facility and patient information from eligibility moduleAuto-populates Patient Visit Information

CPT Codes can be entered or staff can be guided to the correct code through incremental text searchSelect Procedure (CPT / ICD) Codes

Pricing Estimator auto-populates with the correct service co-pay, co-insurance and deductible from the Eligibility ResponseAuto-populates Benefit Information from the Eligibility Response

Patient total out-of-pocket is instantly calculated and notes can be entered to be added to the payment letter

Simplified Accurate Estimates

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 effortsCustomized LettersQES-Revenue360 Benefits & ResultsGuide your staff to make the right decisions for every patient, every timeError reduction prevents common errorsEnforces compliance to your processAllows staff to focus on patients instead of policiesImproves 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 payMaximize collections from both payer and patientIncrease cash, lower AR Days, reduce rework & bad debt

Benefits of the Revenue360 Platform

Copyright 2011 NTT DATA Corporation40

BEFORE AFTERTotal patient revenueIncreased point-of-service revenueDecreased AR Days

Actual Customer ResultsCopyright 2011 NTT DATA Corporation41Questions & AnswersTHANK YOU!

For more information go to:www.revenue360.net

Daily Session Evaluation Sheet GiveawayDont 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 drawingsYou are in Session CXX

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