AGED CASH REPORT

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AGED CASH REPORT

  1. 1. Cardiology www.RemitDATA.com
  2. 2. Overview of Reimbursement Pro™ What is Reimbursement Pro? Reimbursement Pro is a web-based reimbursement tool that works alongside ANY practice management software on the market including Medisoft/Lytec©, Medical Manager/Intergy©, Mysis/Medic©, GE/Centricity©, NextGen© and many more! Reimbursement Pro tools include management reports, collection tools, and benchmark comparative studies. Best of all -there’s NO NEW SOFTWARE to buy or install. Our goal is to help you better manage your reimbursement process so you can get what’s coming to you- your cash! What is the benefit? INCREASED CASH FLOW and IMPROVED PRODUCTIVITY! It’s that simple. Our tools provide you with a proven way to work collections, accelerate your cash and cut your labor costs. The results have been outstanding with most clients reducing denials by 20-30% and saving countless hours of labor. Please read our real-life testimonials on the next page. What do I get? Reports, tools, benchmark studies and much more (see examples on following pages): 1. Insight™ Management Reports: These real-time reports help you pinpoint problematic collection issues and eliminate the source. With one click, you can review your overall denial rate, most common denial reasons, denial rates by procedure, aging reports, and much, much more. And these reports can be broken out by payer, by physician, by collector, etc. Use these management tools to determine if you have an intake issue, a billing issue, a process issue, an education issue or a disciplinary issue. Many RemitDATA clients have lowered their average denial rate to under 5% which means a HUGE improvement in cash flow! These reports help you IDENTIFY problematic reimbursement trends and fix them. 2. QuickTurn™ Collection Tools (Including our new “Q”) : QuickTurn tools are a collector’s DREAM! While our Management Tools help you track and improve reimbursement, QuickTurn was built to help collectors to “work” those collections more efficiently. Most providers still use antiquated processes and paper-based systems to work collection is. Reimbursement Pro users simply log into their account and click on their “Q” where collections are worked in a dynamic and real-time environment. And managers can track the Q to see where denials are in-process and monitor results. The result is that your staff doesn’t work from stacks of paper EOBs, but from a real-time, web-based tool that organizes and prioritizes their workflow. Faster cash, less labor. These tools help you work collections more quickly and effectively. How does it work? The service is simple. We get copies of your Electronic Remittance Notices (ERNs) as you receive them - either direct from the payer (Medicare, Blue Cross, Medicaid, Aetna, Cigna, etc.), or from your clearinghouse if you use one. Not getting ERNs? No worries! Our highly-trained staff can help get you set up. Once set-up, our solution AUTOMATICALLY uploads copies of your ERNs. You simply log into your HIPAA-secure web account and start improving your cash flow immediately! No software, no servers, no hassles! What are the next steps? Try it out for free! If you are not convinced of the value - then you owe us NOTHING. If you like what you see, simply sign up, and pay the low annual subscription fee. Please call 866885-2974, email moreinfo@remitdata.com or visit www.remitdata.com to set up your trial today. © 2008 RemitDATA, Inc. All Rights Reserved Telephone (866) 885-2974 | Fax (901) 312-7770
  3. 3. Testimonials “RemitDATA is an excellent management tool to track, evaluate and correct internal reimbursement processes. It is extremely user friendly and allows the user to work denials with ease. I would recommend this product to anyone who wants to get a better handle on denials in their practice.” - Rick Roney, Executive Director, Montgomery Cardiovascular Associates “Because of Reimbursement Pro, we have been able to significantly reduce our denials for invalid diagnoses by educating our physicians and billing staff. Without it, there is no way we would have been able to pin point the problem areas. - Eddie Barber, Executive Director, Cardiology Associates of North Mississippi “If I took RemitDATA's Reimbursement Pro™ away from my billing department, they would kill me.” - Jeanne Sakamoto, Practice Administrator, Santa Monica Hematology Oncology “We’ve been using RemitDATA’s Reimbursement Pro™ for some time now, and have found it to be extremely helpful in our reimbursement process. We are glad to recommend this innovative company.” - Vishal Ganju, Operations Manager, Ashland Bellefonte Cancer Center “Our company has been involved in Oncology reimbursement for many years and frankly, I was blown away by the power of Reimbursement Pro™. This simple-to-use web-based tool will provide tremendous value to our clients and to any physician practice seeking to accelerate cash flow, increase productivity and reduce expenses." - Pete Lauterbach, CEO, AmerOnc, Inc. "By utilizing RemitDATA's Reimbursement Pro™ our billing staff has substantially reduced the time it takes to bill and follow up on secondary claims. Integrating the software into our billing process has resulted in a measurable improvement in our accounts receivable for our Medicare pay classes." - Steven Elconin, Executive Director, Tower Hematology Oncology Medical Group “RemitDATA’s Reimbursement Pro™ has been a tremendous benefit to our practice. Our investment in their low annual subscription fee has paid for itself many times over. And we love the integrated document imaging of WebScan Pro™. What a powerful combination!” -Linda Edwards, Practice Manager, Hope Community Cancer Center “We first signed on with RemitDATA because my staff loved the OnDemand EOBs and I loved the Management reports. Since becoming a customer we have learned there is MUCH more to this powerful web-based tool. Reimbursement Pro™ has helped us to increase our efficiency and accelerate our cash in a way that has made a serious impact to our bottom line.” -Krista Crump, Practice Manager, Hematology-Oncology Associates “Southeast Cancer Network (SCN), Inc. is a leading cancer center in the Southeast and we are always seeking ways to improve our operations. SCN has used a competitive solution to Reimbursement Pro for nearly a year now. We were so impressed with the process improvements, reporting tools and customer support that we made the change to Reimbursement Pro™." - Brian Driskill, VP of Operations, Southeast Cancer Network © 2008 RemitDATA, Inc. All Rights Reserved Telephone (866) 885-2974 | Fax (901) 312-7770
  4. 4. Reimbursement Pro Report Descriptions NOTE: Reimbursement Pro is compatible with ALL commercial payers who provide an ANSI-compliant ERN. Reports can be created for an entire practice or separated by physician, payer, collector, etc. These reports are available “realtime” (as soon as your ERN is uploaded), or can be set to “auto-generate” on a weekly or monthly predetermined date. Reimbursement Pro is 100% web-based, and 100% flexible to meet your needs. 1. Executive Dashboard Report: This report gives you a quick glance of 5 major “gauges” of your overall performance. In less than 60 seconds, the dashboard highlights your AR team’s performance and directs your steps towards fixing problem areas. 2. Claim Summary By Reason Code: This report tells you WHY you were denied, ranking the Medicare Reason Codes from most frequent denials to least. Problem codes can be identified and reduced/eliminated through staff education or billing process enhancements. Finding out WHY you are being denied is the first step! 3. Claim Summary by Reason Code and Procedure: This report reflects the reason codes listed above, but also lists each procedure (under each reason code) that was denied (ranked by dollar amount). Use this report to pinpoint the reason for claim denials as well as procedures being denied with those codes. The report shows your most common denials first with procedures receiving those codes ranked from highest $ billed to lowest. Pinpoint procedures receiving your most common denials codes, find examples easily in the claim detail report and investigate why you were denied. Then, provide training, new processes or audits to eliminate the denials. 4. Claim Summary by Procedure: This report gives your denial rate by procedure, ranking them by dollars billed. Some companies prefer to look at their data from a “product line” standpoint, and this report is for them. This report can be sorted down to the modifier level to further determine the source of the denial problem. 5. Claim Summary by Procedure and Reason: This report reflects the same procedure codes listed above, but provides a drill down into the REASON codes generated each time a procedure is billed. This report is the SAME as #3 above, except it is sorted FIRST by procedure AND THEN by reason code. 6. Aged Claims Report: Is your staff working old claims? Chances are you have no way of knowing without this report. This report summarizes and groups claims by whether they are paid or denied and then by aging bucket. 7. Average Payment Lag By Procedure: This report tells you the average age (DSO) for each procedure. “Hold Days” tells the number of days from the “Date of Service” to the day Medicare received the claim. “M/C Days” tells the number of days Medicare had the claim before adjudication. This report makes an EXCELLENT scorecard to motivate your AR team! 8. Charge Master Review-Carrier: This is an excellent management report that allows you to quickly review your charge master by payer. You can see, by payer, procedure and in total, the percentage of your billed charges that a payer is allowing and paying. Look for items with percentages of 100% (you may be billing below allowables!), or below 50% (you should reconsider taking assignment on these items!). YOU CAN ALSO EASILY PREDICT YOUR WEEKLY CASH FLOW WITH THIS REPORT! 9. OnDemand EOB: Click hyperlinks on the Claim Detail Report or use our powerful web search engine (screen shot of the web search engine displayed below) to produce HIPAA compliant, patient specific EOBs to your screen in only a few seconds! Just think –no more stacks of un-needed EOB cluttering up desks, no photocopying, no black magic markers. It is a collector’s dream come true! Only the EOB you want – only when you need it. In fact, we become your electronic “EOB Filing Cabinet” from your start date forward. A HUGE time-saver which can pay for the service in less than 90 days! 10. Q – Workflow Management Tool: Reimbursement Pro contains “Q”, our new powerful work-flow management tool. Now, instead of working from paper EOBs, or from existing printed reports, collectors simply log into their “Q” each morning to begin working their denials. From the Q, they can work denials, pull patient-specific EOBs, create Review Forms, add status notes, transfer to other users, and more. Managers can then track the results via Q reports and User Performance metrics. Q is truly the future of working denials. You have to try it to believe it! 11. OnDemand Forms: What a time-saver! If you are weary of hand-writing the necessary Review forms, then you will LOVE our new OnDemand Forms feature! Once our service confirms that a denial will require the review process, we pre-populate a report and place it into your weekly batch. This unique service NOT ONLY saves you 10-15 minutes per form, but guarantees 100% accuracy versus manual copying. Medicare, Blues, state Medicaid forms and many more!! Huge time-saver! © 2008 RemitDATA, Inc. All Rights Reserved Telephone (866) 885-2974 | Fax (901) 312-7770
  5. 5. Aged Cash Graph Payor Adjudication Summary Most Common Denial Codes Unexpected Denials Only PI97 180 + EXPECTED 15.85% DENIALS 151-180 2.36% OA24 121-150 0-30 69.5% 9.92% DENIALS PI97 15.85% 91-120 31-60 18.6% 7.38% OA24 9.92% 61-90 61-90 3.6% PR18 8.31% 31-60 91-120 4.1% PR18 PR16 7.05% 121-150 2.1% 8.31% CO18 5.03% 151-180 0.4% PR16 Others 53.84% 180 + 1.7% 7.05% Total: 100.00% Total: 100.0% PAID 90.26% CO18 0-30 Others 5.03% PAID DENIALS 90.26% 7.38% 53.84% EXPECTED DENIALS 2.36% Total: 100.00% Denied=Allowed of $0, EXP Denial = PR96/46/204 or PR50/57 with GA DOS to Pymt Date or GY Modifier. Downcode=CO57 and allowed >$0. Denial Rates By Procedure DSO by Procedure For Top 10 Procedures Ranked by $ Paid Days Sales Outstanding For Top 10 Procedures Ranked by $ Paid 20% 50 16% 40 Denial Rate 12% 30 44 45 45 8% 17% 20 38 32 32 32 14% 29 27 30 10 4% 8% 8% 7% 7% 6% 6% 5% 3% 0 $240,000 0% $240,000 $ Paid $160,000 $ Paid $160,000 $80,000 $80,000 $0 $0 Procedure 5 7 0 0 0 4 5 0 8 0 Procedure 46 30 98 51 21 01 32 47 48 50 5 7 0 0 0 4 5 0 8 0 78 93 92 93 99 93 93 78 78 A9 46 30 98 51 21 01 32 47 48 50 78 93 92 93 99 93 93 78 78 A9 Unexpected Denials Only PAY DATES FROM 3/1/2008 TO 3/31/2008 FOR ABC Cardiology Associates © 2008 ALL RIGHTS RESERVED Report ID: 93 Monday, April 14, 2008 Page 1 of 1
  6. 6. CLAIM SUMMARY BY REASON CODE PAY DATES FROM 3/1/2008 TO 3/31/2008 FOR ABC Cardiology Associates BILLED ALLOWED PAID COUNT PERCENT Unexpected Denials PI97 - Payment adjusted because the benefit for this service is included in the $29,440 $0 $0 227 16% payment/allowance for another service/procedure that has already been adjudicated. This change to be effective 4/1/2008: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. OA24 - Payment for charges adjusted. Charges are covered under a capitation $44,060 $0 $0 142 10% agreement/managed care plan. This change to be effective 4/1/2008: Charges are covered under a capitation agreement/managed care plan. PR18 - Duplicate claim/service. $31,473 $0 $0 119 8% PR16 - Claim/service lacks information which is needed for adjudication. At least $39,534 $0 $0 101 7% one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) CO18 - Duplicate claim/service. $24,333 $0 $0 72 5% PR27 - Expenses incurred after coverage terminated. $25,710 $0 $0 70 5% CO50 - These are non-covered services because this is not deemed a `medical $31,345 $0 $0 67 5% necessity' by the payer. CO16 - Claim/service lacks information which is needed for adjudication. At $13,628 $0 $0 65 5% least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) PR109 - Claim not covered by this payer/contractor. You must send the claim to $9,294 $0 $0 53 4% the correct payer/contractor. PR26 - Expenses incurred prior to coverage. $28,972 $0 $0 53 4% PI96 - Non-covered charge(s). At least one Remark Code must be provided $9,890 $0 $0 50 3% (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) PR32 - Our records indicate that this dependent is not an eligible dependent as $11,353 $0 $0 48 3% defined. OAB13 - Previously paid. Payment for this claim/service may have been $11,866 $0 $0 44 3% provided in a previous payment. CO97 - Payment adjusted because the benefit for this service is included in the $6,670 $0 $0 35 2% payment/allowance for another service/procedure that has already been adjudicated. This change to be effective 4/1/2008: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. PR31 - Claim denied as patient cannot be identified as our insured. This change $7,220 $0 $0 30 2% to be effective 4/1/2008: Patient cannot be identified as our insured. © 2008 ALL RIGHTS RESERVED Report ID: 20 Monday, April 14, 2008 Page 2 of 8
  7. 7. CLAIM SUMMARY BY REASON AND PROCEDURE PAY DATES FROM 3/1/2008 TO 3/31/2008 FOR ABC Cardiology Associates PROCEDURE BILLED ALLOWED PAID COUNT PERCENT Unexpected Denials PI97 - Payment adjusted because the benefit for this service is included in the $29,440 $0 $0 227 16% payment/allowance for another service/procedure that has already been adjudicated. This change to be effective 4/1/2008: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. 93307 ECHO EXAM OF HEART $18,575 $0 $0 143 63% 78465 HEART IMAGE (3D), MULTIPLE $6,650 $0 $0 47 21% 93543 INJECTION FOR HEART X-RAYS $900 $0 $0 6 3% 75724 ARTERY X-RAYS, KIDNEYS $655 $0 $0 1 0% 93015 CARDIOVASCULAR STRESS TEST $600 $0 $0 3 1% 93545 INJECT FOR CORONARY X-RAYS $480 $0 $0 2 1% 93325 DOPPLER COLOR FLOW ADD-ON $420 $0 $0 7 3% 93312 ECHO TRANSESOPHAGEAL $255 $0 $0 6 3% 99223 INITIAL HOSPITAL CARE $175 $0 $0 1 0% 93556 IMAGING, CARDIAC CATH $170 $0 $0 2 1% 93555 IMAGING, CARDIAC CATH $160 $0 $0 2 1% 78890 NUCLEAR MEDICINE DATA PROC $100 $0 $0 2 1% 99255 INPATIENT CONSULTATION $90 $0 $0 2 1% 92980 INSERT INTRACORONARY STENT $85 $0 $0 1 0% 99221 INITIAL HOSPITAL CARE $85 $0 $0 1 0% 99212 OFFICE/OUTPATIENT VISIT, EST $40 $0 $0 1 0% OA24 - Payment for charges adjusted. Charges are covered under a capitation $44,060 $0 $0 142 10% agreement/managed care plan. This change to be effective 4/1/2008: Charges are covered under a capitation agreement/managed care plan. 92980 INSERT INTRACORONARY STENT $7,254 $0 $0 2 1% 78465 HEART IMAGE (3D), MULTIPLE $6,057 $0 $0 5 4% 33249 ELTRD/INSERT PACE-DEFIB $3,686 $0 $0 1 1% 93510 LEFT HEART CATHETERIZATION $3,232 $0 $0 3 2% 93307 ECHO EXAM OF HEART $2,212 $0 $0 8 6% 99232 SUBSEQUENT HOSPITAL CARE $1,874 $0 $0 16 11% 93641 ELECTROPHYSIOLOGY EVALUATION $1,544 $0 $0 1 1% 93320 DOPPLER ECHO EXAM, HEART $1,486 $0 $0 8 6% A9500 Tc99m sestamibi $1,420 $0 $0 4 3% 93015 CARDIOVASCULAR STRESS TEST $1,286 $0 $0 4 3% 93545 INJECT FOR CORONARY X-RAYS $1,129 $0 $0 3 2% 78478 HEART WALL MOTION ADD-ON $1,103 $0 $0 5 4% 78480 HEART FUNCTION ADD-ON $1,101 $0 $0 5 4% J0152 Adenosine injection $1,006 $0 $0 3 2% 93325 DOPPLER COLOR FLOW ADD-ON $909 $0 $0 8 6% 93543 INJECTION FOR HEART X-RAYS $615 $0 $0 3 2% 99255 INPATIENT CONSULTATION $608 $0 $0 2 1% 99213 OFFICE/OUTPATIENT VISIT, EST $579 $0 $0 8 6% 93556 IMAGING, CARDIAC CATH $532 $0 $0 3 2% 93555 IMAGING, CARDIAC CATH $481 $0 $0 3 2% 99244 OFFICE CONSULTATION $476 $0 $0 2 1% 99254 INPATIENT CONSULTATION $476 $0 $0 2 1% 93880 EXTRACRANIAL STUDY $436 $0 $0 1 1% 93925 LOWER EXTREMITY STUDY $433 $0 $0 1 1% 93744 ANALYZE HT PACE DEVICE DUAL $338 $0 $0 2 1% © 2008 ALL RIGHTS RESERVED Report ID: 20 Monday, April 14, 2008 Page 2 of 39
  8. 8. CLAIM SUMMARY BY PROCEDURE PAY DATES FROM 3/1/2008 TO 3/31/2008 FOR ABC Cardiology Associates % OF PROCEDURE DENIAL RATE BILLED ALLOWED PAID COUNT TOTAL 78465 HEART IMAGE (3D), MULTIPLE 16% $637,558 $246,537 $184,596 629 3% UNEXPECTED DENIALS $46,210 $0 $0 87 14% EXPECTED DENIALS $9,733 $0 $0 11 2% PAID $581,615 $246,537 $184,596 531 84% 92980 INSERT INTRACORONARY STENT 9% $398,659 $105,553 $84,302 127 1% UNEXPECTED DENIALS $29,088 $0 $0 10 8% EXPECTED DENIALS $5,000 $0 $0 2 2% PAID $364,571 $105,553 $84,302 115 91% 93307 ECHO EXAM OF HEART 18% $358,296 $121,061 $87,655 1,196 6% UNEXPECTED DENIALS $37,096 $0 $0 198 17% EXPECTED DENIALS $4,313 $0 $0 20 2% PAID $316,887 $121,061 $87,655 978 82% 93510 LEFT HEART CATHETERIZATION 10% $299,801 $71,361 $58,436 326 2% UNEXPECTED DENIALS $28,649 $0 $0 27 8% EXPECTED DENIALS $2,856 $0 $0 6 2% PAID $268,296 $71,361 $58,436 293 90% 93320 DOPPLER ECHO EXAM, HEART 7% $205,513 $49,091 $36,066 998 5% UNEXPECTED DENIALS $12,081 $0 $0 53 5% EXPECTED DENIALS $1,596 $0 $0 13 1% PAID $191,836 $49,091 $36,066 932 93% 93015 CARDIOVASCULAR STRESS TEST 7% $153,759 $62,179 $44,773 528 3% UNEXPECTED DENIALS $8,720 $0 $0 30 6% EXPECTED DENIALS $1,643 $0 $0 7 1% PAID $143,396 $62,179 $44,773 491 93% 93325 DOPPLER COLOR FLOW ADD-ON 7% $140,025 $43,265 $32,475 1,019 5% UNEXPECTED DENIALS $8,803 $0 $0 61 6% EXPECTED DENIALS $913 $0 $0 10 1% PAID $130,309 $43,265 $32,475 948 93% A9500 Tc99m sestamibi 6% $127,840 $93,314 $69,852 368 2% UNEXPECTED DENIALS $7,360 $0 $0 21 6% © 2008 ALL RIGHTS RESERVED Report ID: 19 Monday, April 14, 2008 Page 1 of 25
  9. 9. CLAIM SUMMARY BY PROCEDURE & REASON CODE PAY DATES FROM 3/1/2008 TO 3/31/2008 FOR ABC Cardiology Associates % OF PROCEDURE REASON CODE DENIAL RATE BILLED ALLOWED PAID COUNT TOTAL 93320 DOPPLER ECHO EXAM, HEART 7% $205,513 $49,091 $36,066 998 5% UNEXPECTED DENIALS $12,081 $0 $0 53 5% OA24 - Payment for charges adjusted. Charges are covered under a capitation $1,486 $0 $0 8 15% agreement/managed care plan. This change to be effective 4/1/2008: Charges are covered under a capitation agreement/managed care plan. PR18 - Duplicate claim/service. $2,338 $0 $0 8 15% PR109 - Claim not covered by this payer/contractor. You must send the claim to the $1,211 $0 $0 6 11% correct payer/contractor. PR27 - Expenses incurred after coverage terminated. $681 $0 $0 5 9% CO50 - These are non-covered services because this is not deemed a `medical necessity' $683 $0 $0 3 6% by the payer. PR16 - Claim/service lacks information which is needed for adjudication. At least one $993 $0 $0 3 6% Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) PR32 - Our records indicate that this dependent is not an eligible dependent as defined. $528 $0 $0 3 6% CO109 - Claim not covered by this payer/contractor. You must send the claim to the $662 $0 $0 2 4% correct payer/contractor. CO16 - Claim/service lacks information which is needed for adjudication. At least one $507 $0 $0 2 4% Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) CO18 - Duplicate claim/service. $506 $0 $0 2 4% PI96 - Non-covered charge(s). At least one Remark Code must be provided (may be $350 $0 $0 2 4% comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) PR26 - Expenses incurred prior to coverage. $662 $0 $0 2 4% PRB9 - Services not covered because the patient is enrolled in a Hospice. This change to $517 $0 $0 2 4% be effective 4/1/2008: Patient is enrolled in a Hospice. CO13 - The date of death precedes the date of service. $331 $0 $0 1 2% OA18 - Duplicate claim/service. $210 $0 $0 1 2% OA96 - Non-covered charge(s). At least one Remark Code must be provided (may be $65 $0 $0 1 2% comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) OAB13 - Previously paid. Payment for this claim/service may have been provided in a $175 $0 $0 1 2% previous payment. PR31 - Claim denied as patient cannot be identified as our insured. This change to be $176 $0 $0 1 2% effective 4/1/2008: Patient cannot be identified as our insured. EXPECTED DENIALS $1,596 $0 $0 13 1% CO45 - Charge exceeds fee schedule/maximum allowable or contracted/legislated fee $765 $0 $0 5 38% arrangement. (Use Group Codes PR or CO depending upon liability). COB22 - This payment is adjusted based on the diagnosis. $240 $0 $0 4 31% OA22 - Payment adjusted because this care may be covered by another payer per $350 $0 $0 2 15% coordination of benefits. This change to be effective 4/1/2008: This care may be covered by another payer per coordination of benefits. OA23 - Payment adjusted due to the impact of prior payer(s) adjudication including $65 $0 $0 1 8% payments and/or adjustments. This change to be effective4/1/2008: The impact of prior payer(s) adjudication including payments and/or adjustments. PR96 - Non-covered charge(s). At least one Remark Code must be provided (may be $176 $0 $0 1 8% comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) PAID $191,836 $49,091 $36,066 932 93% CR2 - Coinsurance Amount ($1,324) ($296) ($211) 4 0% CR38 - Services not provided or authorized by designated (network/primary care) ($60) $0 $0 1 0% providers. CR50 - These are non-covered services because this is not deemed a `medical necessity' ($435) $0 $0 5 1% by the payer. PR27 - Expenses incurred after coverage terminated. $65 $65 $0 1 0% PR96 - Non-covered charge(s). At least one Remark Code must be provided (may be $1,014 $532 $1 4 0% comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) © 2008 ALL RIGHTS RESERVED Report ID: 19 Monday, April 14, 2008 Page 6 of 80
  10. 10. AGED CLAIMS REPORT PAY DATES FROM 3/1/2008 TO 3/31/2008 FOR ABC Cardiology Associates AGING BILLED ALLOWED AMOUNT PAID PERCENT PAID CLAIMS 0 - 30 $2,727,086.53 $1,086,310.24 $875,799.92 69% 31 - 60 $965,003.35 $328,692.78 $234,331.06 19% 61 - 90 $151,849.70 $61,077.40 $45,201.73 4% 91 - 120 $110,641.00 $58,323.93 $51,659.94 4% 121 - 150 $73,143.00 $31,871.74 $26,924.56 2% 151 - 180 $17,104.45 $6,970.99 $5,521.11 0% 181+ $218,126.25 $105,587.48 $21,507.50 2% TOTALS $4,262,954.28 $1,678,834.56 $1,260,945.82 AGED FROM DOS TO PAYMENT DATE 33 AVERAGE AGE OF PAID CLAIMS DENIED CLAIMS - UNEXPECTED ONLY 0 - 30 $122,682.00 $0.00 $0.00 30% 31 - 60 $58,761.00 $0.00 $0.00 15% 61 - 90 $68,343.22 $0.00 $0.00 17% 91 - 120 $57,666.50 $0.00 $0.00 14% 121 - 150 $29,711.00 $0.00 $0.00 7% 151 - 180 $18,902.50 $0.00 $0.00 5% 181+ $47,006.50 $0.00 $0.00 12% TOTALS $403,072.72 $0.00 $0.00 AGED FROM DOS TO DENIED DATE 83 AVERAGE AGE OF DENIED CLAIMS TOTAL $4,666,027.00 $1,678,834.56 $1,260,945.82 NOTE: Claim reversals (CR codes) are excluded from both the paid and denied sections. The denied section is reporting only on unexpected denials. © 2008 ALL RIGHTS RESERVED REPORT ID 160 Monday, April 14, 2008 Page 2 of 2
  11. 11. PAYER DSO PERFORMANCE PRIMARY PAYERS 30 40 30 40 30 40 20 50 20 50 20 50 10 60 10 60 10 60 0 70 0 70 0 70 CAHABA GBA -MS PART B BLUE CROSS BLUE SHIELD OF MS BLUE CROSS BLUE SHIELD OF ALABAMA 30 40 30 40 30 40 20 50 20 50 20 50 10 60 10 60 10 60 0 70 0 70 0 70 WISCONSIN PHYSICIANS BLUE CROSS & BLUE Others SERVICE INS. CORP . SHIELD POST PRIMARY PAYERS 40 50 40 50 40 50 30 60 30 60 30 60 20 70 20 70 20 70 10 80 10 80 10 80 0 90 0 90 0 90 BLUE CROSS BLUE SHIELD OF MS BLUE CROSS & BLUE SHIELD BLUE CROSS BLUE SHIELD OF ALABAMA 40 50 40 50 40 50 30 60 30 60 30 60 20 70 20 70 20 70 10 80 10 80 10 80 0 90 0 90 0 90 CAHABA GBA -MS PART B UNITED HEALTHCARE INSURANCE Others COMPANY DSO = DATE OF SERVICE TO CHECK DATE PAY DATES FROM 3/1/2008 TO 3/31/2008 FOR ABC Cardiology Associates © 2008 ALL RIGHTS RESERVED Report ID: 14 Monday, April 14, 2008 Page 1 of 6
  12. 12. AVERAGE PAYMENT LAG BY PROCEDURE PAY DATES FROM 3/1/2008 TO 3/31/2008 FOR ABC Cardiology Associates PROCEDURE COUNT HOLD DAYS PAYER DAYS TOTAL DAYS TOTAL AMT PAID Primary Claims 13,542 16 14 33 $1,198,191 78465 HEART IMAGE (3D), MULTIPLE 439 14 15 29 $178,368 ** CAHABA GBA-MS PART B 258 14 15 28 $77,395 BLUE CROSS BLUE SHIELD OF MS 109 Data not provided by payer 25 $73,582 BLUE CROSS BLUE SHIELD OF ALABAMA 36 Data not provided by payer 49 $16,368 WISCONSIN PHYSICIANS SERVICE INS. CORP. 23 15 16 31 $6,020 BLUE CROSS & BLUE SHIELD 12 18 7 25 $4,575 UNITED HEALTHCARE INSURANCE COMPANY 1 14 22 36 $427 93307 ECHO EXAM OF HEART 725 20 14 42 $83,058 ** CAHABA GBA-MS PART B 399 14 14 28 $34,960 BLUE CROSS BLUE SHIELD OF MS 93 Data not provided by payer 26 $19,410 BLUE CROSS BLUE SHIELD OF ALABAMA 77 Data not provided by payer 117 $15,246 BLUE CROSS & BLUE SHIELD 31 28 8 36 $5,664 WISCONSIN PHYSICIANS SERVICE INS. CORP. 101 19 16 36 $5,527 CAHABA GBA-AL PART B 14 138 8 146 $1,377 UNITED HEALTHCARE INSURANCE COMPANY 7 39 41 80 $563 BCBS KS-FEDERAL EMPL PGM 2 15 5 20 $206 PREMIER BLUE 1 299 0 299 $105 92980 INSERT INTRACORONARY STENT 93 16 15 43 $82,384 ** CAHABA GBA-MS PART B 66 16 14 30 $39,469 BLUE CROSS BLUE SHIELD OF MS 12 Data not provided by payer 94 $22,887 BLUE CROSS BLUE SHIELD OF ALABAMA 11 Data not provided by payer 65 $16,304 BLUE CROSS & BLUE SHIELD 1 41 5 46 $1,991 WISCONSIN PHYSICIANS SERVICE INS. CORP. 3 20 24 44 $1,733 A9500 Tc99m sestamibi 299 11 15 26 $68,236 ** CAHABA GBA-MS PART B 209 11 15 26 $40,684 BLUE CROSS BLUE SHIELD OF MS 90 Data not provided by payer 25 $27,552 93510 LEFT HEART CATHETERIZATION 241 19 14 43 $55,905 ** CAHABA GBA-MS PART B 148 17 14 32 $22,232 BLUE CROSS BLUE SHIELD OF MS 38 Data not provided by payer 49 $17,565 BLUE CROSS BLUE SHIELD OF ALABAMA 33 Data not provided by payer 87 $9,393 BLUE CROSS & BLUE SHIELD 9 42 7 48 $4,418 WISCONSIN PHYSICIANS SERVICE INS. CORP. 11 23 16 39 $1,905 UNITED HEALTHCARE INSURANCE COMPANY 1 11 28 39 $213 CAHABA GBA-AL PART B 1 9 12 21 $179 99214 OFFICE/OUTPATIENT VISIT, EST 745 11 14 25 $45,362 ** CAHABA GBA-MS PART B 469 14 14 29 $27,679 WISCONSIN PHYSICIANS SERVICE INS. CORP. 121 3 16 19 $7,295 BLUE CROSS BLUE SHIELD OF MS 86 Data not provided by payer 19 $5,994 BLUE CROSS & BLUE SHIELD 26 3 8 11 $1,863 CAHABA GBA-AL PART B 19 8 12 20 $1,108 BLUE CROSS BLUE SHIELD OF ALABAMA 19 Data not provided by payer 31 $1,096 UNITED HEALTHCARE INSURANCE COMPANY 3 7 14 21 $185 BCBS KS-FEDERAL EMPL PGM 2 1 5 6 $143 93015 CARDIOVASCULAR STRESS TEST 403 12 15 27 $42,849 BLUE CROSS BLUE SHIELD OF MS 118 Data not provided by payer 23 $19,697 CAHABA GBA-MS PART B 225 11 15 26 $15,060 BLUE CROSS BLUE SHIELD OF ALABAMA 35 Data not provided by payer 40 $5,437 © 2008 ALL RIGHTS RESERVED Report ID: 14 Monday, April 14, 2008 Page 2 of 6
  13. 13. AVERAGE PAYMENT LEVEL COMPARISON BY PAYER PRIMARY PAYMENTS ONLY 100% 16% 11% 90% 27% 36% 34% 16% 37% 80% 39% 50% 14% 0% 51% AVG % OF BILLED AMT 70% 61% 69% 60% 16% 2% 13% 14% 50% 14% 12% 40% 0% 70% 73% 73% 30% 59% 51% 7% 50% 49% 20% 38% 36% 37% 10% 24% 0% 14280 - BLUE 14281 - 14294 - UNITED 14295 - UNITED 14296 - 14299 - BLUE 14300 - BCBS 14301 - 14302 - BLUE 14304 - UNITED 14305 - CROSS BLUE CAHABA HEALTHCARE HEALTHCARE CAHABA CROSS BLUE KS-FEDERAL PREMIER BLUE CROSS & BLUE HEALTHCARE WISCONSIN SHIELD OF MS GBA-MS PART INSURANCE INSURANCE GBA-AL PART B SHIELD OF EMPL PGM SHIELD INSURANCE PHYSICIANS B COMPANY COMPANY ALABAMA COMPANY SERVICE INS. CORP. TOP 10 PAYERS RANKED BY TOTAL $ PAID PAID BY PAYER PATIENT PAY/SECONDARY DISALLOWED BY PAYER NOTE: Your most profitable payers will have the highest percentages paid and lowest percentages disallowed. Patient Pay and Secondary amounts often require more efforts to collect. "PAID BY PAYER" reflects actual primary amounts paid as a percentage of total billed. "PATIENT PAY/SECONDARY" Reflect the amount allowed by payer less amounts paid expressed as a percentage of total billed. This category DOES NOT reflect actual patient pay or secondary amounts. "DISALLOWED BY PAYER" represents dollars billed minus dollars allowed as a percentage of dollars billed. © 2008 ALL RIGHTS RESERVED Report ID: 16 Friday, April 18, 2008 Page 1 of 10
  14. 14. CHARGE MASTER REVIEW - TOP 30 PROCEDURES BY PAYER PAY DATES FROM 3/1/2008 TO 3/31/2008 FOR ABC Cardiology Associates AVG PERCENT PERCENT PERCENT PROC CODE COUNT QTY OF BILLED AVG PAID OF ALLOWED TOTAL PAID AVG BILLED ALLOWED OF BILLED 78465 HEART IMAGE (3D), MULTIPLE 447 447 $1,120 $494 44% $399 36% 81% $178,368 BLUE CROSS BLUE SHIELD OF MS 115 115 $1,197 $808 68% $640 53% 79% $73,582 CAHABA GBA-MS PART B 260 260 $1,192 $374 31% $298 25% 80% $77,395 UNITED HEALTHCARE INSURANCE COMPANY 1 1 $910 $427 47% $427 47% 100% $427 BLUE CROSS BLUE SHIELD OF ALABAMA 36 36 $910 $477 52% $455 50% 95% $16,368 BLUE CROSS & BLUE SHIELD 12 12 $495 $475 96% $381 77% 80% $4,575 WISCONSIN PHYSICIANS SERVICE INS. CORP. 23 23 $597 $327 55% $262 44% 80% $6,020 93307 ECHO EXAM OF HEART 763 763 $346 $142 41% $109 32% 77% $83,058 BLUE CROSS BLUE SHIELD OF MS 108 108 $410 $251 61% $180 44% 72% $19,410 CAHABA GBA-MS PART B 412 412 $400 $116 29% $84.85 21% 73% $34,960 UNITED HEALTHCARE INSURANCE COMPANY 6 6 $168 $61.81 37% $61.81 37% 100% $371 CAHABA GBA-AL PART B 14 14 $249 $123 49% $98.37 39% 80% $1,377 BLUE CROSS BLUE SHIELD OF ALABAMA 80 80 $236 $200 85% $191 81% 95% $15,246 BCBS KS-FEDERAL EMPL PGM 2 2 $150 $115 76% $103 69% 90% $206 PREMIER BLUE 1 1 $150 $105 70% $105 70% 100% $105 BLUE CROSS & BLUE SHIELD 32 32 $274 $230 84% $177 65% 77% $5,664 UNITED HEALTHCARE INSURANCE COMPANY 1 1 $310 $192 62% $192 62% 100% $192 WISCONSIN PHYSICIANS SERVICE INS. CORP. 107 107 $204 $67.29 33% $51.66 25% 77% $5,527 92980 INSERT INTRACORONARY STENT 95 95 $3,371 $1,045 31% $867 26% 83% $82,384 BLUE CROSS BLUE SHIELD OF MS 14 14 $3,558 $2,076 58% $1,635 46% 79% $22,887 CAHABA GBA-MS PART B 66 66 $3,553 $754 21% $598 17% 79% $39,469 BLUE CROSS BLUE SHIELD OF ALABAMA 11 11 $2,500 $1,482 59% $1,482 59% 100% $16,304 BLUE CROSS & BLUE SHIELD 1 1 $2,100 $1,991 95% $1,991 95% 100% $1,991 WISCONSIN PHYSICIANS SERVICE INS. CORP. 3 3 $2,100 $722 34% $578 28% 80% $1,733 A9500 Tc99m sestamibi 302 604 $176 $138 79% $113 64% 82% $68,236 BLUE CROSS BLUE SHIELD OF MS 93 186 $176 $176 100% $148 84% 84% $27,552 CAHABA GBA-MS PART B 209 418 $176 $122 69% $97.33 55% 80% $40,684 © 2008 ALL RIGHTS RESERVED Report ID: 16 Friday, April 18, 2008 Page 2 of 10
  15. 15. Reimbursement Pro contains OnDemand EOB™ that creates a patient-specific EOB on-demand. No more will your staff need to file, find, copy, mark up, and recopy EOBs. And you can use the “Ordered EOBs” option to create a specific batch of patient-specific EOBs in the EXACT ORDER that your secondary bills are printed! Your secondary person simply puts your EOBs with HCFA 1500s and they are done! Saves lots of money on copier costs and labor.
  16. 16. CAHABA GBA-MS PART B MEDICARE P.O. BOX 548 REMITTANCE BIRMINGHAM, AL 352010548 NOTICE (866) 419-9454 PROVIDER #: 3000018 PAGE #: Page 1 of 1 DATE: 03/26/2008 CHECK/EFT #: 2000084 PERF PROV SERV DATE POS NOS PROC MODS BILLED ALLOWED DEDUCT COINS GRP/RC-AMT PROV PD NAME: HALL, SCOTT HIC: 100005427 ACNT: 115898-3 ICN: 0208079194750 ASG Y MOA: MA01 5000000088 0304 030408 11 1 93015 333.00 0.00 0.00 0.00 OA24 333.00 0.00 5000000088 0304 030408 11 1 78465 1,448.00 0.00 0.00 0.00 OA24 1,448.00 0.00 5000000088 0304 030408 11 1 78478 253.00 0.00 0.00 0.00 OA24 253.00 0.00 5000000088 0304 030408 11 1 78480 252.00 0.00 0.00 0.00 OA24 252.00 0.00 5000000088 0304 030408 11 2 J0152 342.00 0.00 0.00 0.00 OA24 342.00 0.00 5000000088 0304 030408 11 2 A9500 360.00 0.00 0.00 0.00 OA24 360.00 0.00 PT RESP 0.00 CLAIM TOTAL 2,988.00 0.00 0.00 0.00 2,988.00 0.00 ADJ TO TOTALS: PREV PD 0.00 INTEREST 0.00 LATE FILING CHARGE 0.00 NET 0.00 GLOSSARY: GROUP, REASON, MOA, REMARK AND REASON CODES OA24 Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. This change to be effective 4/1/2008: Charges are covered under a capitation agreement/managed care plan. MA01 Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair toyou, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late. In order to comply with HIPAA privacy regulations, this patient-specific Medicare Remittance Notice has been independently reproduced by RemitDATA, Inc. It was created from a Medicare Electronic Remittance Advice (ERA) in accordance with the standard paper remittance format stipulated by CMS.
  17. 17. RemitDATA’s new “Q” is the FUTURE of reimbursement management! Managers can pull up the overall Q, and then assign rules so that work is sorted into each collector’s individual Q. Collectors then log into their specific Q and work and update their denials. Managers are able to monitor the overall Q, and track the workload and performance of all the team members.
  18. 18. Reimbursement Pro contains “Q”, our new powerful work-flow management tool. Now, instead of working from paper EOBs, or from existing printed reports, collectors simply log into their “Q” each morning to begin working their denials. From the Q, they can work denials, pull patient-specific EOBs, create Review Forms, add status notes, transfer to other users, and more. Managers can then track the results via Q reports and User Performance metrics. Q is truly the future of working denials. You have to try it to believe it!
  19. 19. RemitDATA’s new “Q” allows you to drill down into the Patient Specific denial screen, where you can review the details of the claim, print up a patient-specific EOB, see all previous denials and history for the claim or patient, create a review or other OnDemand Form, update the status, assign to other users, and much, much more! With WebScan Pro integration, you can easily retrieve needed documents to attach to the claim for resubmission!!
  20. 20. Reimbursement Pro offers OnDemand Form which allows quick generation of various short pay letters, dunning letters and review forms. Forms can be complete and ready to send with just a few key strokes and mouse clicks!
  21. 21. Reimbursement Pro contains OnDemand Forms™, which eliminates the need to manually complete Review Forms and more. Our easy-to-use online version takes a FRACTION of the time of the paper-based version, AND is guaranteed to be 100% accurate (many manually completed Review forms contain multiple errors due to the mind-numbing process of copying data by hand). Simply find the claim(s) you want to review, and then use the auto-populate tools to complete the form and click “Generate Review”. AND, if you are a WebScan™ client, then you can attach any documents which have been scanned into the system! Another huge time-saver. See page 1.
  22. 22. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES MEDICARE REDETERMINATION REQUEST FORM COLLINS, STEPHEN E 1. Beneficiary’s Name:_____________________________________________________________________ 100008587 2. Medicare Number: ______________________________________________________________________ 3. Description of Item or Service in Question: __________________________________________________ 9330726, 9332026, 9332526 03/13/2008, 03/13/2008, 03/13/2008 4. Date the Service or Item was Received: _____________________________________________________ 5. I do not agree with the determination of my claim. MY REASONS ARE: Insert reason here!!!! _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 6. Date of the initial determination notice ______________________________________________________ (If you received your initial determination notice more than 120 days ago, include your reason for not making this request earlier.) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 7. Additional Information Medicare Should Consider: ____________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Mary Jones 8. Requester’s Name:______________________________________________________________________ 9. Requester’s Relationship to the Beneficiary: _________________________________________________ 10. Requester’s Address: ____________________________________________________________________ , _____________________________________________________________________________________ 11. Requester’s Telephone Number: ___________________________________________________________ (555) 555-5555 12. Requester’s Signature: ___________________________________________________________________ 04/21/2008 13. Date Signed: __________________________________________________________________________ 14. J I have evidence to submit. (Attach such evidence to this form.) J I do not have evidence to submit. NOTICE: Anyone who misrepresents or falsifies essential information requested by this form may upon conviction be subject to fine or imprisonment under Federal Law. Form CMS-20027 (05/05) EF 04435/2005
  23. 23. Don’t forget our other innovative web-based solutions to help your practice achieve optimal efficiency! WebScan™ is a powerful, document management solution that works via the web. All you need to get started is a scanner and stuff to scan! Simply scan a batch of documents (CMNs, EOBs, Invoices, Employment Documents, AP Info, Patient Satisfaction Surveys, etc.) into a network folder and WebScan™ automatically detects the new batch and uploads it to your account on one of our 100% HIPAA Secure servers located in our state-of-the-art data center. Sales PRO™ is the leading web-based software program for the homecare industry allowing sales and marketing professionals to track, evaluate and monitor their work. Sales PRO™ tracks how to best reach your accounts, a continuous call report for accounts, key account issues and so much more.

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