I think what you are asking for is proration (reimbursement management)
and claim holds. These holds stop accounts before they drop a claim for
various reasons. In order to set them up, you have to know what you are
currently receiving denials for. For example, Payers in contract with a
facility may require authorization - and possibly you are getting high
volumes of denials for authorizations for a particular payer.
Authorizations required by payer can be set up (1) to reject at the
registration point, (2) at the point where the account hits BAR (UR
Claim Check), (3) at the point where the BAR attempts to post / cut the
account (proration or reimbursement management) and at the Claim level.
(1) MIS Insurance Dictionary - Required Fields Dictionary -
Questionnaires
(2) UR Claim Check - BAR, Claim Check Dictionary, Prescreen
UR
Accounts = "Y"
(3) Bar, Claim Check and Reimbursement Management
Dictionaries
(4) Bar, Claim Check and Claim Dictionaries
This is a simple example, but I think you get the point.
Not all proration holds can be used as UR Claim Checks and not all Claim
Checks can be used as proration holds.
We have numerous claim and proration holds as well as admission
requirements. These holds stop the account before getting out the door
and can be tracked on your DNFB (discharge not final billed) UR Claim
Rejections and/or Master Claim Rejection Lists. In C/S (not sure about
Magic), the holds can be assigned to 'groups' which allow the reports to
pull by the responsible area. For us, the areas are to run them daily
to make corrections and the numbers are reported to higher management
(dollars and number of accounts).
Kim Scaccia, System Admin
Recovery Reimbursement
Patient Business & Financial Services
Halifax Medical Center
386-226-4590 opt 1 ext 2018
-----Original Message-----
From: meditech-l@MTUsers.com [mailto:[EMAIL PROTECTED] On Behalf
Of Wiltshire, Sandi
Sent: Tuesday, June 05, 2007 2:39 PM
To: meditech-l@MTUsers.com
Subject: [MEDITECH-L] B/AR question
Hi, I am posting this for our Director of Pt Financial
Services....Thanks for your help, Sandi
To B/AR module users:
What if any program is being utilized to identify claims that will deny
processing either thru MT or the payer systems due to missing
information, wrong information etc. I currently have a process when the
claim denies for payment once it has made it thru the payer claim edits.
What I am looking for is pre submission to the payer.
I am interested in collection of the data so that the information can be
fed back to the department managers responsible for patient
registration.
Thanks
Terry Hibbert
Director, Patient Financial Services
Heywood Hospital
978-630-6209
978-630-6153 Fax
[EMAIL PROTECTED]
Sandi Wiltshire, MT(ASCP),MBA
IS Applications Manager
Heywood Hospital
242 Green Street
Gardner,Ma. 01440
978-630-6112
[EMAIL PROTECTED]
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