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HealthCo: Centricity Clearinghouse Overview
The document provides an overview of Centricity EDI Services, emphasizing its benefits for improving patient care and financial performance for independent physician practices. Key features include hosted claims management, denial analytics, and integrated eligibility verification, which together enhance workflow efficiency and reduce claim denials. The presentation outlines successful case studies demonstrating significant improvements in collections and operational efficiency after transitioning to the Centricity platform.
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HealthCo: Centricity Clearinghouse Overview
- 1. Centricity Clearinghouse Overview Presented by: Jason Porter,HealthCo Information Systems
- 2. Today’s Presenter Jason Porter VicePresident HealthCo Information Systems
- 3. • National Partnerfor GE Healthcare • Support thousands of physicians in their use of the Centricity EMR/PM platform • Founded in 1997 • Located in Portland, OR • Mission to improve patient care and financial performance of independent physician practices
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- 8. Product Overview: Denials IQ Powerfulalgorithm analyzes claims data weekly to provide dashboards that reveal denial trends by code, payor, physician, location and a number of other categories, allowing the clinic to rework denials in bulk and set rules via HCM to prevent these denials in the future.
- 9. Agenda 9 • Welcome • CentricityEDI Services Overview • Hosted Claims Manager and DenialsIQ™ • What is Next? • Summary
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- 11. Switching Clearinghouse’s Isa PAIN…Right? 11 Situation: Using non-integrated CH and experiencing reduced cash flow, higher than desired AR and denial rates. Fix: Converted to the CEDI platform for Claims, Remit, Eligibility, HCM and DIQ Results: “The transition was beyond easy, it was a smooth process. The HealthCo implementation team even monitored my first week of claims to make sure there were no glitches. Our collections have improved by over 20% and the doctors are VERY HAPPY!” Clinic Profile: 2 Ortho Surgeons 1 PT 2 locations including an ASC Contact: Melissa Miller, Billing Manager mmiller@prairiespine.com
- 12. EDI Services integratespayer information directly into the financial management process $220B Processed annually by Centricity EDI Services 620M Transactions processed annually by Centricity EDI Services 10+ Years Staff average EDI experience Claim Submission Payer Integration Advanced Payment Tracking Analytical dashboard Analytics Denial & rejection management Auto Claim Status Inquiry Payment Automation Claim Scrubbing Eligibility2,100+ Clients utilizing EDI Services from GE Healthcare
- 13. Service model GE HealthcareService Model • Single vendor solution • We design, build, and maintain transaction setup • GE Healthcare provides All Payer Connectivity • 24/7 Production Control monitoring on all transactions Proactive Monitoring & Support • Production Control Team • Monitoring Tools • Performance Metrics Integration • Built-in to Practice Management System • Centricity EDI is part of core workflow Focus on Revenue Cycle: • Payer Edits • Claim Scrubbing • Clean Claims • Reduce Rejected Claims • Reduce Denied Claims • Reduce days to Payment • Increased cash flow Work Flow Efficiency: • Automation • Reduce Re-work • Improve process
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- 15. Insurance eligibility checking 15 CentricityEDI’s Eligibility Verification allows customers to utilize a highly automated exception-based workflow to quickly verify patient eligibility • Why Eligibility: • Improve customer’s ability to collect full or partial payment (copay to deductible) • Inform the patient of their financial responsibility at the time of arrival – particularly with High- deductible Health Plans (HDHP) • Prevention of rejections & denials • Reduce labor costs and improve productivity (fewer phone calls!)
- 16. Centricity EDI Services:Transaction Flow HTTPSCentricity PM Centricity® EDI Services Real- time Data Center Centricity EDI Services owns setup and ongoing maintenance Full integration with Centricity PM Real-time Production Control 24/7 Store and Forward EHNAC and CORE Payer Trading Partner Payer Payer Payer Payer 271 Response 270 Request Payer Transactions monitored for response and timeliness Average response time is 10-20 seconds
- 17. Centricity Practice Solutionintegrated eligibility workflow 17
- 18. Insurance claim submission 18 Customersutilizing GE’s claims service enables an integrated, complete workflow coupled with near 100% electronic coverage Why Electronic Claims: • High % of electronic claims saves money • EDI Dashboard for real-time file and claim tracking • Extensive claim, remittance, and denial reporting • Integrated product ensures efficient workflow and follow-up • Proactive monitoring reduces insurance follow-up time • Same day delivery of claims & acknowledgement reduces cycle time
- 19. EDI Dashboard • Real-timeinsight into claim and remittance tracking • Centralized view of payer mandate updates • Summary of top rejections and denials • Detailed insights into payer rejections as well as suggested actions
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- 21. Payer Edit Integration(PEI) 21 Integration of front-end (pre-adjudication) edits received from clearinghouse and/or payer Provides integration into the Claims Tab while updating the status of tickets Why Payer Edit Integration: • Insurance follow up from Centricity Practice Solutions • “Root cause” reporting from Centricity Practice Solutions • Reduction in rejection rate • Improves resolution time and reduce time to completion • Integration with Centricity Practice Solutions
- 22. Integrated EDI editsin Centricity Practice Solution
- 23. Electronic remittance advice 23 CentricityEDI Services remittance submissions provides near 100% electronic remittance transactions posted directly into your practice management system Integration enables standardized denials and high auto-post rates After posting, standardized analytics to help you identify denial trends Why Electronic Remittance : • A connected product supports more efficient workflow and follow-up • Labor savings by automatically posting and integration • Use of standard denial codes to drive automation and process improvement • Same-day delivery supports faster follow-ups • Extensive ERA file history and check summary reporting • Ability to re-queue missing ERA files on the fly
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- 25. ERA file history& check summary Reconciliation and real-time file tracking made easy
- 26. Remit Summary –Denial Category Customize denial reporting to identify workflow inefficiencies
- 27. Hosted Claims Manager andDenialsIQ
- 28. Claim scrubbing 28 Hosted ClaimsManager is a rules- based, front-end clinical editing tool that allows you to review claims before submission Reduce claim denials Shorten your accounts receivable cycle Increase the rate of collections • Why Hosted Claims Manager: • $25 average cost per claim for rework* • 15% industry average for claims that are rejected or denied* • Clinical edits are integrated into your approval process • Real time response • Rules updated bi-weekly • Low implementation effort * Source: Optum, 2015
- 29. Claim scrubbing 29 • Proven,industry-leading clinical editing engine including LMRP/NCD/LCD • Edits can be created specific to your local payers guidelines • Edits can be turned off if not needed Submit Correct Scrub
- 30. Clinical edits...What arethey? Duplicates Established/New Patient Medicare Local Coverage Determinations/ National Coverage Determinations (LCD/NCD) Correct Coding Initiative Edits (CCI) Bundling Edits Modifier relationship to procedure code Diagnosis relationship to procedure code Maximum frequency Global periods Injection codes
- 31. DenialsIQ 31 Advanced statistical algorithms fromGE Global Research identify patterns by root cause factors DenialsIQ automatically surfaces unseen patterns in denials to help capture missed opportunities Focus teams on resolving the denials rather than finding the denials • Why DenialsIQ: • Built on Predix™, follows Fastworks development methodology … quick to respond to change • Alert and share invoice details with staff to take necessary action to resolve claim denial • High cost to rework denials • 2% denials write-offs equaled of net patient revenue* • *Advisory Board Revenue Cycle Benchmark Study
- 32. DenialsIQ 32 • Dynamic visualizationshelp prioritize opportunities to work denials more quickly • Defines pattern details and root cause to prevent future occurrences • Advanced dashboards filter in order to monitor and report performance over time
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- 36. DenialsIQ and HostedClaims Manager 36 Hosted Claims Manager is an ideal complementary solution to DenialsIQ, our advanced analytics solution that uncovers unseen trends based on your claim denials. Uncover coding patterns/denials in DenialsIQ then look to what can be resolved with Hosted Claims Manager to prevent future denials and rework; thus creating a closed loop solution.
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- 41. Benefits of CentricityEDI Services Clean Claims Improve financial performance Workflow Efficiency Reduce costs True Integration – built in! Value added services – single vendor Compliance
- 42. Pricing Overview: Bundle #1: HostedClaims Manager and Denials IQ Bundle #2: CEDI Claims, Remit, Eligibility 43 % Savings 13 % Savings Bundle #3: Full CEDI Program 26 % Savings Special Pricing Expires 3/15/17
- 43. > Resources • GE CEDIInformation including case studies and brochures lindah@healthcosystems.com jasonp@healthcosystems.com For product questions and information: For pricing details and questions about your current EDI tools: