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Revenue Management

Maximize your agency revenue and increase compliance. Four components of our Revenue Management module work together to deliver a valuable solution: Eligibility Checking, Prior Authorization Tracking, Pre-bill Compliance Checklist and Billing. Each of these features can be customized based on your agency’s needs. Handles billing to MassHealth, commercial carriers, Medicare and self-pay.

Eligibility Checking

  • Daily automated eligibility checks.   Automatically checks active MassHealth patients daily, in accordance with regulations.
  • Highlights eligibility issues. Prevent income loss from uncovered services when patients have no coverage or are with a non-contracted carrier.
  • Identifies patient data changes. Identifies differences in patient name and Medicare ID# so you can maintain accurate patient records.
  • Documented eligibility history.  Retains a history of patient eligibility results.

Prior Authorization Tracking

  • PA Tracker. Track the status of your PA’s to ensure the continuity of authorization for your patient care, preventing gaps in revenue coverage.  Eliminate the need for cumbersome spreadsheets.
  •  PA File Repository. Store approval letters for quick reference.
  •  Ties into Billing.  Bill batches will split claims by PA period, reducing claim denials.
  •  E-forms.  Option to use e-forms of R&J or Universal Authorization form to use for submission to the payer.

Pre-billing Compliance Checklist

  • Compliance Focus.  The pre-bill compliance checklist identifies the clinical documentation or actions needed to establish benefit eligibility criteria for each patient’s episode, helping the whole of your operations become more focused on achieving compliance.  It even includes hints of what to look for in each document.
  • Customization. You may structure the checklist to meet the specific policies and procedures of your Agency, including which items will put a hold on billing the episode.
  • Ties into billing. Episode visits will be withheld from bill batches until the required documents are verified complete.

Billing

  • Batch Billing. Generates all claims that meet your bill batch criteria at a click of a button.
  • Error Validation. Validates if required data is in the claims based on payor requirements, ensuring clean claims are submitted.
  • Automated Coordination of Benefits. Automatically incorporates the coordination of benefits details into MassHealth claims for Medicare dual-eligible patients, eliminating the need to manually add this for each of these claims in the POSC.
  • Automated Submission. Automatically submits the claim batches for you.
  • Claim Tracker. Tracks the payment status of each claim, so no claim payment is forgotten about.
  • Automated MassHealth Claim Payment Status Updates. Automatically logs the MassHealth payment status on each claim within hours of submission.
  • Auto-reconciliation. Will reconcile each claim that pays 100% of billed amount, so you focus attention only on those that need it.
  • EMR Visit Imports. Allows you to import visits from your EMR (Axxess, Kinnser), so you can process for billing and payroll efficiently.
  • Medicare TPL Demand Billing Management. Creates special TPL Demand Bill claims to submit to Medicare, and includes a page to manage each letter’s progression through completion.
  • Medicare ADR Status Tracking and Document Repository. Track the status of ADRs (Additional Document Requests), and store the documents required for processing an ADR for quick view and accessibility.
  • Payer Profiles. Customize the comprehensive settings for your Payers.  Includes self-pay accounts for invoicing.