Category: For Hospitals & Physician Groups

Stay informed on the latest industry news, best practices, and trends in revenue cycle management for hospitals and physician groups.

Why Month-End Cash Posting is Scarier than Halloween

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For a cash posting manager, Halloween’s got nothing on the horrors of manual splitting, posting, and reconciling remittances.

Skeletons and ghouls are not nearly as frightening as an impending month-end with all your posting staff working overtime to post and reconcile receipts. Needing to resolve a patient payment issue but not having a way to efficiently look up all payments posted to the patient’s account—that’s a lot more anxiety-inducing than a haunted house.  

Before Adena Health System began using RemitMax™ by Quadax, the staff spent a lot of time printing and scanning lockbox documents, because the bank only retained three months’ worth of correspondence and paper remittance data.  Paper documents waiting to be scanned filled cabinet after cabinet, which delayed insurance follow-up work, delayed answers to customer service questions, and also delayed cash posting.  Referencing the source documents to solve any posting errors meant combing through the cabinets armed with the deposit date of the batch.  If the deposit date had been entered into the scan incorrectly, they would likely never find the document, since that was all they had to search by.

Now that’s a horror story.

Implementing RemitMax at Adena Health System brought about numerous improvements for the entire business office.  One of the early wins was the document retention, the excellent search functionality, and the elimination of the perpetual printing and scanning of paper remittances and correspondence by Adena staff.  Another was the ability to reassign staff to more valuable follow-up work because of the huge time savings that RemitMax has helped them realize with automatic splitting and electronic posting.

Angela Lowery, Cash Posting Revenue Cycle Manager at Adena Health System in Ohio, will be discussing revenue cycle life before and after RemitMax when she presents “Transforming Remittance Management into a High-Performance Operation,” a live webinar on Thursday, November 1, 2018, at 2:00 p.m. (EDT).

Register For Webinar

 

Angie is enthusiastic about the difference that RemitMax has made in the entire business office at Adena Health System—for lockbox savings, for morale, for improved customer service, and for better follow-up and the opportunity for revenue recovery.  Join us to hear more about Adena’s transformational experience with RemitMax by Quadax!

To read more about RemitMax, download the e-book, Surviving the Paper Storm. If you would like to learn how RemitMax can transform your business office, Request a Demo!

Hanging in the Balance: Addressing Surprise Billing Issues

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The topic of balance billing is in the news again, closely associated with the newer term, “surprise billing.”  Patient experiences such as those of Drew Calver, who received an unexpected $109K bill following treatment for his heart attack, have focused new attention on this long-standing issue.

Balance billing is the practice of pursuing from the patient any balance remaining on account after the insurance payer has reimbursed its portion to the provider, beyond the expected co-pay, co-insurance, and deductible.  The terms of the contract between the provider and insurance plan will generally dictate what is or is not billable to the patient – the aforementioned co-pay, co-insurance, deductibles, for example – and these contract provisions (and state law, typically) will control whether or not a patient may have further financial responsibility.

When there is no contract, of course, all bets are off, since an out-of-network provider has no negotiated payment rate.  As high-deductible health plans have become more widespread, many patients are keenly aware of the benefits of staying in-network to keep those expected costs as affordable as possible. But what about when services must be rendered by an out-of-network provider?

In a number of cases highlighted by the media recently, a patient was not aware that out-of-network providers were engaged in the treatment.  This commonly happens when an emergency department physician working through a staffing agency, or an anesthesiologist or radiologist is involved in care but is not in-network. Hence, the surprise of “surprise billing” – the receipt of an out-of-network bill when the patient thought they were at an in-network facility.

New Jersey’s Assembly Bill No. 2039 has likewise garnered quite a bit of attention since its enactment and particularly since its effective date August 30, 2018. Governor Phil Murphy, who signed the legislation earlier this year, said “We’re closing the loophole and reining in excessive out-of-network costs to prevent residents from receiving that ‘big surprise’ in their mailbox. At the same time, we’re making healthcare more affordable by ensuring these costs are not transferred to consumers through increased health premiums.”

New Jersey is among 21 states that have partial or comprehensive protections against balance billing by out-of-network providers in emergency departments or in-network hospitals. Stipulations of the protections vary by state.  Variables include applicability by setting, type of managed care plan, the type of protection, and the payment outcome, whether a payment standard or a dispute resolution process. And since ERISA currently exempts self-funded employer sponsored plans from state regulation, 61% of privately insured individuals are not covered by their state’s protections, adding to the complexity.

There is speculation that changes could be made to ERISA (the Employee Retirement Income Security Act of 1974) to overcome this loophole to state protections.  Senator Bill Cassidy, M.D. (R-LA) announced on September 17 a discussion draft of a bill that would modify ERISA to defer to state limits for patient costs for emergency care; or, in absence of state limits, define restrictions within the proposed legislation itself to cap patient responsibility.  This is one issue among several concerning healthcare price transparency that is being discussed by a working group, and not the only discussion on the topic of potential laws governing balance billing.

So what’s a healthcare provider to do?

  • Be aware of the regulations applicable in your state, and be prepared to comply. As media focus continues on this topic, more legislators are taking up the issue.  Stay tuned to your state’s law-making process to eliminate surprises for your cash flow.
  • Apply your organization’s payment policies consistently.
  • Communicate clearly with patients, whenever possible, about the charges they should expect and their options for payment. In non-emergency settings, check patient eligibility, and provide a pre-service estimate based on their health plan coverage.

Complex billing issues are par for the course in today’s healthcare business office. That’s why Quadax delivers software and solutions that solve revenue cycle complexities, streamlining accounts receivable and reimbursement operations to improve cash flow and payment results.

If you’re ready to work with a partner that believes in transparency, communication, and earning our clients’ trust every day, get in touch with Quadax!

Collect More Revenue with “Clean” Claims

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When it comes to healthcare claims, cleanliness is next to, at the very least, fiscal fitness. Producing claims that are “clean” and therefore immediately reimbursable is an important factor in reducing cost-to-collect, especially in an environment where the growth of costs (7.5%) are outpacing revenue (6.6%).[i]  While some denials are inevitable, reducing your denial exposure is all about producing claims that can be paid, and can be paid now.

Two metrics important to the discussion of creating claims most likely to be immediately reimbursable are Clean Claim Rate (CCR) and First Pass Rate (FPR).  Though sometimes confused for one another, these are separate statistics, each worthy of optimization.

HFMA identifies the value of CCR as an indicator of the quality of data collected and reported.  This measure is captured through your claims processing tool, and is calculated as the number of claims that pass edits requiring no manual intervention divided by the total number of claims accepted into the claims processing tool for billing.

A high CCR indicates that the data collected and processed by the EHR may be presumed to be high-quality. That quality may be attained in one of a few ways. Well-defined processes throughout the revenue cycle, from patient intake through coding on to accurate claim production processes in the EHR, will be reflected in a high CCR.  Another way to achieve a high CCR is by applying a meticulous routine of incoming claim data conversions within the claim processing tool to overcome EHR shortcomings and human error.  Or, a combination of both factors may be in play. In any case, the effect is faster time to payment with reduced manual labor for reduced operational expense.

Another important metric is the first-pass rate (FPR): the percentage of claims which are accepted for adjudication by payers on the first transmission. This measure indicates the reliability of your claims management system: the quality of its claim editing routines is critical; so is the accurate generation of 837s to meet each payer’s unique specifications, including the correct placement of each data element. The most common reason for claim rejections is missing/incorrect data.  By catching those errors – and even better, by facilitating automated correction of such errors – the claim processing tool with a high first-pass rate also contributes to faster time to payment, and impacts manual labor expense by reducing manual correction and resubmission. For a provider processing 100,000 claims per month, a variance as little as 1% in your first-pass rate can mean an additional 1,000 claims that must be manually reviewed.

Some organizations make the choice to abandon the pursuit of an exceptionally high CCR in favor of moving claims out the door as quickly as possible.  Follow-up staff must then be mobilized to handle the resulting rejections (bounced back to the clearinghouse with errors flagged, never having made it into the payer’s adjudication system) as well as denials.  Other organizations choose to weight the process at the billing stage, examining every claim prior to release to head off the potential for follow-up work down the road.

An imbalance favoring either manual pre-work or post-work is likely to add to the cost of claims management. Greater value can be realized by balancing quality and quantity with a holistic approach to creating cleaner claims and reducing denials that incorporates intelligent efficiency and automation.

In summary:

  1. Work toward data accuracy throughout the revenue cycle to contribute toward a higher CCR.
  2. Make use of automation in your claims management tool to apply data conversions to overcome known shortcoming in your system or process during claim intake to achieve an even higher CCR.
  3. Rely on a clearinghouse with a high FPR, like Quadax, to get your clean claims into adjudication as quickly and reliably as possible.

Learn more about streamlining your claims management process in our free infographic that cues you into Roadblocks, Pile-ups, and Bottlenecks in Claims Processing.

Would you like to learn how much improvement your business office would see with an improved CCR and an industry-leading FPR rate?  Click here to get in touch with us – we’d love to talk!

[i] “Moody’s: Preliminary FY 2016 US NFP hospital medians edge lower on revenue, expense pressure,” Moody’s Investors Service, May 16, 2017. https://m.moodys.com/research/Moodys-Preliminary-FY-2016-US-NFP-hospital-medians-edge-lower–PR_366813

Quadax Earns KLAS Top Ranking for Claims Management

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The Secret is Out! 

With the release of the 2018 Best in KLAS: Software and Services report, the healthcare industry is learning what Quadax clients have known for years: Quadax can’t be beat for exceptional service and top-performing product functionality.

Although Quadax has served hospitals, laboratories, physician groups, and many others in the healthcare industry for more than 40 years, we have done so somewhat quietly. “Quadax is the industry’s best kept secret; a small but mighty company with talent and expertise to help all types of providers,” said Terry Buterbaugh, Senior Software Engineer.

Instead of making a lot of noise, we’ve focused our attention on building partnership with our clients.  We continuously work to improve our revenue cycle products and services to meet the needs of providers looking for high-performing transaction management tools to improve operational efficiency and cash flow, cost-effectively.

Quadax Performance

You expect comprehensive standard edits for cleaner claims and faster payments, and Quadax delivers.  Thanks to the diligence of our team of claim edit researchers, 99.6% of the claims we transmit are accepted by payers on the first pass. The Quadax Claims Management system, Xpeditor, also gives you powerful tools for configuration of custom edits and claim data processing rules as well as dynamic workflow rules to fit your business office. Not the other way around.

Inseparable from our superior products are the people of Quadax EDI Services that empower providers to use the Xpeditor system to its fullest by providing person-to-person, relational customer support. Whether it’s on-site, on the phone, through virtual meetings, or otherwise—we’re here for you.

Quadax is honored to receive the distinction of Category Leader for Claims Management. However, the driving force behind all that we do is not the achievement of a trophy or seal. Rather, it’s the attainment of a relationship of trust and mutual benefit with the healthcare providers we serve. We enjoy overcoming new challenges as they arise, rolling up our sleeves, and working with client teams to help them achieve success.

If the power and flexibility of Xpeditor are news to you, we’d love to let you in on the secret. Contact us so we can give you more information and show you what makes Quadax Claims Management #1!

KLAS Research

KLAS is a data-driven company on a mission to improve the world’s healthcare by enabling provider and payer voices to be heard and counted. Working with thousands of healthcare professionals, KLAS collects insights on software, services and medical equipment to deliver reports, trending data and statistical overviews. KLAS data is accurate, honest and impartial. The research directly reflects the voice of healthcare professionals and acts as a catalyst for improving vendor performance.

Each year, KLAS publishes a Best in KLAS Report, identifying the top vendors in more than 80 categories.  “Category Leader is more than a ranking. It is a recognition of vendors committed to delivering superior solutions,” said Adam Gale, President of KLAS. “It gives voice to thousands of providers who are demanding better performance, usability and interoperability in healthcare technology.”

The Best in KLAS Report scores vendors on the performance categories sales and contracting, implementation and training, functionality and upgrades, service and support, and general. What they learned put Quadax at the top of the list.

KLAS data is freely available to healthcare providers on their website. You can learn more about KLAS and the insights they provide, and download the 2018 Best in KLAS: Software & Services Report when you log in or create a free account.

Quadax earns top scores by KLAS for Claims Management

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As a testament to the superior customer service and support we provide our clients, Quadax received top marks as the best overall performing claims management vendor in the 2017 Claims and Denials Management 2017 Report by KLAS Research.  Download the report.

“Some vendors do much better at providing high-quality service and support, which is almost transformative in moving the experience from a vendor/customer relationship to more of a partnership.”  –KLAS Research

“Quadax topped the chart for claims management vendors that establish partnerships with their provider organizations.”  –Jacqueline Belliveau, RevCycleIntelligence

Quadax thanks our clients for entrusting us with their business. Creating long-lasting partnerships only strengthens our commitment to providing you continued high-quality customer service and support along with the best solutions in the industry.

RevCycleIntelligence.com article: KLAS: Quadax, SSI Group Earn Top Scores for Claims Management