Revenue360 for QES version 13Nick 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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What’s the most complex job in healthcare?
Quote from a Director of Registration for an Ohio hospital
It takes me 2 years to train a registrar to learn all they need to know …
…but they leave after 6 months!
The Challenge…
AUTOMATES MANUAL PROCESSES - IMPROVES EFFICIENCY - REDUCES COSTS AND BAD DEBT - INCREASES PRE-SERVICE CASH COLLECTIONS
Get it Right the First Time!
The right information
To the right person At the right time In the right format
Computerized guidance ensures your best practice process is followed – preventing many errors that lead to denials and rework
Just In Time Knowledge Distribution
QES-Revenue360® Address Validation
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
QES-Revenue360® Address ValidationDemonstration
QES-Revenue360® Address Validation
QES-Revenue360® Demographic Validation
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.
Types of 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.
Red Flags Requirements
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
QES-Revenue360® Demographic ValidationDemonstration
QES-Revenue360® 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
Benefits of Address & Demographic Validation
QES-Revenue360® Eligibility Verification
Invalid Mem-ber ID
Invalid Group
#NoReferral
No Pre-Auth
Inel-igi-ble
Service not covered
National Registration ErrorsMost 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 VerificationDemonstration
QES-Revenue360® Eligibility Verification
The Response Summary simplifies interpreting benefit coverage and discrepancies of what was returned from the insurance company
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Intelligent 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 request
Eligibility – Response Summary
Full Response is always available for reference now – or later in Billing Office
The full 271 response is always just a tab away so that all benefit coverage information is easily accessible
Eligibility – Full Response
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
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Eligibility Worklists help manage workflow and find historical transactions
Eligibility – Worklists
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Eligibility 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 facilities
Eligibility – Standalone Verification
QES-Revenue360® Pricing Estimation
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?
Can you communicate the patients true out-of-pocket cost?
Three major components:1. Charges (Adjudicated Claims)2. Eligibility and Benefit Coverage3. Insurance Contracts
Total Estimated Amount: $759.72Estimated Patient Amount: $389.07Total Allowable Amount: $445.33
Calculate patient total out-of-pocket cost
QES-Revenue360® Pricing Estimation Demonstration
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When pricing estimate can be provided, “Send to Pricing Estimator” button sends the eligibility response to the Pricing Estimation Module
Requesting a Price Estimation
Pricing Estimation auto-populates facility and patient information from eligibility module
Auto-populates Patient Visit Information
CPT Codes can be entered or staff can be guided to the correct code through incremental text search
Select Procedure (CPT / ICD) Codes
Pricing Estimator auto-populates with the correct service co-pay, co-insurance and deductible from the Eligibility Response
Auto-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 efforts
Customized Letters
QES-Revenue360® Benefits & Results
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
Benefits of the Revenue360 Platform
BEFORE AFTER
Total patient revenue
Increased point-of-service revenue
Decreased AR Days
Actual Customer Results
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
