[MT-L] BAR and Claims Best Practices

[Gura, Leslie]

We are wondering how different hospitals handle the mainenance of Insurance/BAR/Claims, dictionaries, maps, data elements, electronic claims and remittance file handling.  Most of the Meditech dictionaries are designed to be maintained by a “super-user” in each module in each area of the hospital.  We are finding that the BAR/Claims functions are more intensive than the typical billing office staff can manage, yet require a level of claim and remittance processing, payer and coding regulations that the typical IT department would not have.

 

Patient Accounting was expected to maintain things as “super-user” when we went live.  The staff did not have the ability to keep up with the extensive maintenance and education involved.  This was made more difficult by our entity undergoing a “streamlined” implementation where Meditech built everything then quickly showed the staff everything without the staff being able to acquire a deep knowledge of the system.  After several months, we experienced a degredation of BAR and Claims.  This has been rectified through work on 5010 and converting to electronic 835 processing.  As we mull over the best way to handle the transition of these functions going forward, we do not want to experience any degredation of the BAR and Claim module.

 

One hospital that we know of has a non-IT staff person maintaining, BAR, Claims, MIS (Insurance and Claims/Remittance processing), and the zGL.  This could be appealing because of the interrelationship of the functions; however, some have proposed dispersing the functions among more than one person in Patient Accounting and/or IT to reduce the staffing burden.  What are some of the other models out there that Meditech users have for BAR/Claims? 

 

Thanks,

Leslie

 

 

 

_____________________________________

 

Leslie A. Gura, MHA, CPA

Senior Financial Consultant

UNC Health Care

211 Friday Center Dr., Suite 2001

Chapel Hill, NC 27517

919-843-3038 (p)

919-966-0086 (f)

919-810-0664 (c)

 

lg...@unch.unc.edu

 

 

 

 

[Kim Scaccia]

It is essential that BAR Claims are maintained, updated and/or modified by someone in the patient accounts area.  If not a super user in that area, then an IT person in that area.  Claims, checks, proration (reimbursement) rules along side of the MIS Insurance and CDM dictionaries can be powerful when used and maintained properly.  It is also crucial that one or two people (only) have the access to test and make changes.  Too many personnel making changes in dictionaries as critical as these will do nothing but cause problems.  The 835 and 5010 set ups can be complex and when coupled with payer specific billing requirements makes the dictionaries and their interdependencies important to understand.  This task can sometimes be overwhelming and should not be taken lightly.  Any user assigned this task should be provided the ability to learn and grow without having a true ‘full load’ of a normal job.  For example, if the choice is to make the lead Medicare biller your super user, that person’s workload should be cut in half to allow for the time, training and maintenance of these dictionaries.

 

If the billing area needs additional training there are organizations that can assist with documentation and training of the staff for maximizing the power within Meditech.  We at Jacobus specialize in Meditech set up and revenue cycle optimization.  If your facility does not want to go down the road of consultants, push Meditech for additional information through the use of documentation, WebEx training and tasks.  Sometimes we lose sight in the fact that Meditech truly does work for our facilities and should thus demand that they provide all information necessary.  There is a wealth of information on Meditech’s website to help facilities learn their interdependencies. 

 

Kimberly Scaccia  | Senior Management Consultant  |  Jacobus Consulting, Inc.

C. 386.871.5605  |  F. 949.713.6742  |  ksca...@jacobusconsulting.com  |  www.jacobusconsulting.com

 

"Together We Transform Healthcare"

 

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[Mitch Lawrence]

Very well said Kim!

 

Thank you,

Mitch Lawrence

D(58)_D(41)^!

NPR/Automation

: MLawre...@gmail.com

: http://www.facebook.com/Mitchell.D.Lawrence

: http://www.linkedin.com/pub/mitch-lawrence/a/9aa/528

[Nadeau, John - PHX]

I believe it needs to be someone in the patient accounts/revenue cycle department responsible for BAR and Claims.  Find a geek in the department that has been around long enough to understand revenue cycle, billing rules, payer rules, etc and who wants to know how the system works, and isn’t afraid to immerse themselves in implementation guides, manuals, etc and who  is able to work well with the other departments (both clinical and administrative).

 

I used to support BAR & Claims exclusively at a magic site.  I started in patient accounts doing billing and collections like most users, so had the exposure to the payer rules, oddities, medicare regulations and payer contracting.  Around the time that 4010 came into play, I started doing all the dictionary work for BAR, did all the testing for and implemented 4010 both for the hospital and home health databases.  Having the support of the director is what allowed me to do it though, I dropped my workload completely, and focused entirely on the system.  Monitoring rejection reports, I implemented hundreds of custom claim checks, doing all of our scrubbing exclusively in Meditech.  I taught myself NPR, created multiple custom process account routines (inquiries, forms) and letters since NPR is so much more flexible than the letter dictionary.  In magic at least, Meditech will link your NPR reports in the toolbox process routine dictionary for use on your custom process account menus. Use NPR to make things easier,  example: as new insurance were created, I had written a report that checked every BAR dictionary for a “like” insurance to find the dictionaries that needed to be updated, including maps and data lists.  As soon as contract updates were received, I got copies of them so that proration rules could be updated.  I did all the testing for ring releases, training for the updates, troubleshooting application issues, working with Meditech to resolve them, and carried a pager and would handle any off hour issues with BAR that the night staff in IT were not able to take care of.  Work with registration. Everything they do impacts BAR.  Develop audit reports to validate data entry, and the associated claim checks if something will cause an electronic file to bomb out.  Work with the clinical departments.  Any order that has a charge attached in one of the clinical modules has the potential to be a problem.  Users charge on wrong accounts, PRE accounts, etc.  This stuff needs to be worked on right away to keep things clean and moving along.

 

Pay this person well.  I left revenue cycle to move into IT since I was not paid as an IT analyst.  But revenue cycle is still my thing, and you can do so much with Meditech BAR, it pays to have someone invest the time and effort into maintaining the system.  Even after all these years, I still do quite a bit for that site. 

 

John Nadeau
Clinical and EHR Application Support  - Meditech
Dignity Health IT
(207) 602-1600 (Office) - (207) 423-6692 (Mobile) - (602) 604-4641 (Fax)

john....@dignityhealth.org

 

Our mission is to make effective resolutions to daily challenges, enhance productivity of the user community and to empower our users by making information technology accessible. We achieve this through  quality IT services and support.

 

 

From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com] On Behalf Of Gura, Leslie
Sent: Wednesday, April 25, 2012 3:16 PM
To: medit...@mtusers.com
Subject: [MT-L] BAR and Claims Best Practices

 

We are wondering how different hospitals handle the mainenance of Insurance/BAR/Claims, dictionaries, maps, data elements, electronic claims and remittance file handling.  Most of the Meditech dictionaries are designed to be maintained by a “super-user” in each module in each area of the hospital.  We are finding that the BAR/Claims functions are more intensive than the typical billing office staff can manage, yet require a level of claim and remittance processing, payer and coding regulations that the typical IT department would not have.

[Taylor, John]

I’ll echo what others have said so far.  This is a specialized area that requires expertise to manage both the technical aspects and the billing cycle.  Mistakes can have an impact on the financial operations of the hospital.

 

The person(s) responsible for this need to understand how BAR, ADM, ABS, MIS, and the GL module relate.  They also need to understand additions to the insurance dictionary require changes to multiple dictionaries in other modules.  They need to understand the relationship between the claim map and remittance advice code dictionaries.

 

We use a partnership between IT and BAR to manage the dictionaries, 837/835 setup, etc.  Still, there are too many folks who have dictionary access that don’t understand the results of all the changes they make.  We are working thru those issues.  It is a cooperative effort between IT and BAR.

 

 

Thanks,

 

John Taylor

Revenue Cycle Analyst, Information Systems | Augusta Health

Office:  (540)332-4882 | www.augustahealth.com

 

From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com] On Behalf Of Gura, Leslie
Sent: Wednesday, April 25, 2012 3:16 PM
To: medit...@mtusers.com
Subject: [MT-L] BAR and Claims Best Practices

 

We are wondering how different hospitals handle the mainenance of Insurance/BAR/Claims, dictionaries, maps, data elements, electronic claims and remittance file handling.  Most of the Meditech dictionaries are designed to be maintained by a “super-user” in each module in each area of the hospital.  We are finding that the BAR/Claims functions are more intensive than the typical billing office staff can manage, yet require a level of claim and remittance processing, payer and coding regulations that the typical IT department would not have.

[Amber Adkins]

I echo what John says!  I am lucky enough to be that person who gets to work full time as an analyst in Revenue Cycle.  My official title is Revenue Cycle Systems Analyst.  I am primary support for BAR, claims, remittances, and all things billing/collecting in two systems (Meditech and our professional billing system Centricity).  I work with IT on the interfaces between the two; and am the primary designer of flow between the two because I understand the unique requirements of both systems and the regulations of each payor, etc.  I also support HIM in conjunction with an IT analyst and work closely with the SCH/ADM analyst.

I have been in this role for 12 years and love my job!  I am very lucky that my boss see’s the value in having a full time employee in Revenue Cycle and has fought over the years to pay me well.  I physically reside in the same building as our billing and collections staff for both systems and report directly to the Revenue Cycle Manager; then the CFO.  Having a management chain above me that is entirely focused on Revenue allows me the support I need when IT department priorities can be stretched across the entire organization.

We to do not use any clearinghouse and maintain hundreds of claims checks, and submit claims direct to payors in 5010 837 format.  Because I understand their daily process and the systems, I have been able to work on many process improvements over the years and get us to a very ‘clean’ and ‘streamlined’ place. 

 

Amber Adkins

 

From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com] On Behalf Of Nadeau, John - PHX

Sent: Thursday, April 26, 2012 6:51 AM
To: 'Gura, Leslie'; medit...@mtusers.com

[Adams, Colleen]

I am another of the B/AR staff that maintain the B/AR module.  I was hired 20 years ago to implement and maintain all financial modules.  My first major install was the Magic B/AR module.  Two years after we installed B/AR, my boss transferred me to the billing department as they felt that the module was too complicated and involved for somebody to maintain along with other modules.  My job was changed to be a combination of B/AR systems and GL entries related to billing.  I am a designated accountant with a love of computers.  The majority of my job (approx 80%) is the systems side.  I have one systems clerk who assists me.  We have converted to the Client/Server version and we run 13 acute care sites plus several ECU sites on a single MIS.  My job maintains all of the interfaces to and from B/AR.  I am the liason between our B/AR department and Meditech, IT and all other super users.  I write all of the NPR reports for B/AR as well.  We also have the Cost Accounting module and we use the electronic statistical capture in B/AR, so our system is quite involved.  We are a Canadian site, so our billing is quite different from yours, but it is still quite complex.  I cannot stress how important it is for the person who maintains B/AR to understand the revenue cycle as if they do not, then your system will become dysfunctional in a very short time period.

Colleen L. Adams, CMA
Coordinator, Accounts Receivable Applications & Reporting
Fraser Health Authority
330 E. Columbia Street
New Westminster, B.C.
V3L 3W7

E-mail:  collee...@fraserhealth.ca
Tel: 604-520-4735
Fax: 604-520-4789

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From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com] On Behalf Of Amber Adkins
Sent: Thursday, April 26, 2012 8:56 AM
To: Nadeau, John - PHX; Gura, Leslie; medit...@mtusers.com

[Russo, Judy]

Is anyone capturing radiation dose from their CT scanners, and interfacing it over to Meditech?

 

Meditech is able to calculate a cumulative dose for the patient, which is nice… but I don’t want the techs to have to enter the exam dose manually.

 

Any tips would be appreciated.  We are Meditech C/s 5.65

 

Thanks, Judy

 

---

 

[Jim Joyner]

Hello,

We are a Magic site migrating to 6.x, MSite server configuration  (remotely hosted by Dell)

 

For whatever reason, Dell & 3M are having a pissing match about the ‘contract’ and installing the 3M software at the Msite.

 

Are there any other Msite hospitals that are also using 3M? If so, we’d love to hear from you in regards to how/if you had to negotiate a three way contract between your site, Msite(Dell) and 3M.

 

Semi related.. are there ANY other coding software companies that also work with Meditech, in an Msite setup?

Our project coordinator drew a big blank, but I’m hopeful someone out there in ‘L’ land has some ideas, suggestions, or at the very least some sympathy.. ~grin~

 

Thanks in advance as always..

 

 

Jim Joyner | Financial Systems Analyst

 

Silverton Health
971983.5368 Direct

503873.1621 Fax

jjo...@silvertonhealth.org

342 Fairview, Silverton, OR 97381 

 

silvertonhealth.org

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[Gary Ring]

I also agree with John and Kim.  It is critical for this support person to have an in-depth understanding of Business Office operations in general, billing practices/workflow specifically, and regulatory requirements.  In addition, I would also want this individual to have a formalized technical/analysis background.  No longer does Business Office support mean simply generating a piece of paper (UB, 1500) and getting it out the door.  With the implementation of HIPAA transactions, ICD-10, edit requirements, and the array of differences that various payers require even with "standard specs", I think it's really important that this individual understand file structure concepts and be able to, as John indicated, delve into the details of the TR3 specifications and be able to translate those specs into operational and system set-up models.  And more importantly, be able to translate these requirements into real-life requirements that MEDITECH can understand, since they don't always have a grasp on the reality of what Business Office staff have to do.

 

I know this type of individual, who possesses all of these traits and characteristics, is generally hard to find.  And given enough time, the right individual can certainly grow into this position.  But with cash flow on the line, organizations don't always have the luxury of fostering organic growth in this position; the job has to be done right the first time.  So if you don't have this type of individual, assistance and mentoring with expert resources would be one way to go.

 

 

Gary J. Ring
President

Ring Consulting, Inc.
978-807-1573
www.ringconsultinginc.com

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[Opfer, Cheryl]

We just had to get a contract with 3M and Dell and didn’t have any problems.

We were warned it would be difficult, but it only took 3 or 4 days.

 

 

Cheryl Opfer RN

Senior Clinical Informatics Analyst

Information Systems

Campbell County Memorial Hospital

501 S. Burma Ave.

Gillette, Wy 82716

P: 307-688-1661

F: 307-688-1667

 

cheryl...@ccmh.net

 

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