Insurance Workflow Tips
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This document provides best practices for medical practices to achieve clean insurance claims and quicker reimbursements. It summarizes the key areas medical practices should focus on, including proper setup of billing settings, daily review of clearinghouse reports, accurate charge entry, timely claim submission, and proper payment posting. The document also highlights various workflow efficiencies that can be gained in Kareo, such as adding users and providers directly in the platform, electronic charge capture, and auto-sending eligible claims.
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Insurance Workflow Tips
- 2. Insurance Reimbursements Workflow Best Practices for Achieving Clean Claims Tracey Peyton, Director of Training and Development Suzi Grasso, Sr. Training Specialist
- 3. Kareo Confidential Agenda 3 Agenda 3 • Introduction • Billing Process Overview • Best Practices for Clean Claims & Quicker Insurance Reimbursements • Improved Workflow Efficiencies in Kareo • Q & A
- 4. Kareo Confidential 44 About The Presenters Tracey Peyton 15+ years SaaS experience ensuring Customer Proficiency by managing and implementing customer training programs. 10+ years implementing internal process improvements, analyzing, developing and training customers on best practices, user workflows and efficiencies that increase productivity and customer satisfaction. Director, Training and Development Sr. Training Specialist and Subject Matter Expert at Kareo Over 15 years of experience in the medical industry as a practice manager and biller 7 years training medical professionals on industry best practices using Kareo solutions Suzi Grasso Sr. Training Specialist
- 5. Kareo Confidential 55 Billing Process Overview
- 6. Kareo Confidential 66 Leading Causes for Claim Rejections Settings 42.53% Eligibility Check 19.10% Kareo Validation 14.44% Code Scrubbing 12.80% Enrollments 8.42% Duplicate 2.71% 43% 14% 19%
- 7. Kareo Confidential 77 Best Practices for Clean Claims & Quicker Insurance Reimbursements Settings • Correct NPI, Payer ID and TAX ID • Provider Information • Enrollments • Overrides Clearinghouse Reports – Check Daily • Claim Processing – Work rejections – Save and Rebill • Electronic Remittance – Confirm payment received Missed Encounters Report • Customize • Save • Subscribe to Practice Users Daily
- 8. Kareo Confidential 88 Best Practices (Cont.) Enter and Approve Charges • Manually • Draft Tab Submit Claims • Electronically • Paper Post Payments • ERAs • EOBs
- 9. Kareo Confidential 99 Improved Workflow Efficiencies in Kareo Tips and Tricks Settings • Add Practice Users in Platform • Add Referring Providers in Platform Charge Capture – Electronically send charges to PM Clearinghouse Reports • Enter Notes • Bulk Review
- 10. Kareo Confidential 1010 Improved Workflow Efficiencies in Kareo Tips and Tricks (cont.) Encounters • Check/View Eligibility on Encounters • View Insurance Information • Additional Diagnosis Codes and Auto Code Scrubbing • Attach Documents for Work Comp. with Jopari Claims • Track Claim Status Issue Type Column • Auto Send Posting Payments • View Contract Rates
- 11. Kareo Confidential 1111 Settings – Add Practice Users in Platform Value and Benefits • Easier process to add practice users • Allows Biller to assign an Admin in Platform • Easily select what modules to activate for each provider • Frees up billers time from maintaining users for every practice. • Gives the practice more freedom to add/delete users as necessary
- 12. Kareo Confidential 1212 Add Practice Users in Platform
- 13. Kareo Confidential 1313 Settings – Add Referring Providers in Platform Value and Benefits • Easy process for practice to add referring providers in Platform • NPI lookup tool auto populates provider information • Saves billers from manually entering in demographic information • More accurate information
- 14. Kareo Confidential 1414 Add Referring Providers in Platform
- 15. Kareo Confidential 1515 Charge Capture Value and Benefits • Electronically send charges to PM • Easy process for practices to add charges directly from the Agenda • No need for paper superbills • No more faxing or delivering charges to the biller • Choose the right insurance case for each visit • Add rendering, referring and supervising providers, if applicable • Submit claims quicker with more accurate information • Take the manual process out of entering charges • Get paid faster
- 16. Kareo Confidential 1616 Charge Capture
- 17. Kareo Confidential 1717 Clearinghouse Reports – Enter Notes Value and Benefits • Easy to notate and assign specific rejections to staff • Easily sort reports that need attention • Easy to spot rejection trends • See comments from the home page view
- 18. Kareo Confidential 1818 Clearinghouse Reports – Enter Notes
- 19. Kareo Confidential 1919 Clearinghouse Reports – Bulk Review Value and Benefits • Save time not opening and looking at reports that don’t need attention • No longer need to clear reports one at a time • Easier to stay organized and on top of things
- 20. Kareo Confidential 2020 Clearinghouse Reports – Bulk Review
- 21. Kareo Confidential 2121 Encounters – Check/View Eligibility Value and Benefits • View eligibility issues from the find encounter screen • No need to leave your workflow to see patient eligibility status • Access full eligibility report with a simple click • Real Time eligibility checks right from the encounter scree
- 22. Kareo Confidential 2222 Encounter – Check/View Eligibility
- 23. Kareo Confidential 2323 Encounters – Insurance Information Value and Benefits • See insurance ID by hovering over insurance name • No need to access the case to see the insureds policy number • Keeps billers in their regular workflow without leaving to find information
- 24. Kareo Confidential 2424 Encounters – Insurance Information
- 25. Kareo Confidential 2525 Encounters – Additional Diagnosis Codes and Auto Code Scrubbing Value and Benefits • Easily add up to 12 diagnosis codes per encounter • Providers may get paid more using additional diagnoses • Catch coding errors before they become rejections • Get paid quicker
- 26. Kareo Confidential 2626 Encounters – Additional Diagnosis Codes and Auto Code Scrubbing
- 27. Kareo Confidential 2727 Encounters – Attaching Documents for Work Comp with Jopari Value and Benefits • Send work comp claims electronically instead of by paper • Get reimbursed quicker • Less hassle than sending by paper • Save money on postage and printing costs
- 28. Kareo Confidential 2828 Encounters – Attaching Documents for Work Comp with Jopari
- 29. Kareo Confidential 2929 Claims – Track Claim Status Issue Type Column Value and Benefits • Visually see issues before submitting claims • Easily sort and correct issues • Prevent rejections
- 30. Kareo Confidential 3030 Claims – Track Claim Status Issue Type Column
- 31. Kareo Confidential 3131 Claims – Auto Send Feature Value and Benefits • Daily claims sent on a clear schedule • More consistent reimbursements • Saves time
- 32. Kareo Confidential 3232 Claims – Auto Send Feature • Auto Send claims twice per day • 8am and 8pm PDT • Only claims that are in a “Ready to send electronically” status will be sent
- 33. Kareo Confidential 3333 Posting Payments – Contract Rates Value and Benefits • Easily see if you are getting paid correctly
- 34. Kareo Confidential 3434 Posting Payments – Contract Rates
- 36. Connect with Kareo Stop by and say hi! Kareo @GoKareo GoKareo Kareo 3353 Michelson Drive, Suite 400 Irvine, CA 92612 (888) 775-2736
Editor's Notes
- SF Claim Rejection codes for 2018 Still feels sort of empty. Lots of blank space not in use. Increase size of pie chart? Feels off balance. Pie chart too large? Be wary of delivering a calca. Want a high-lvl summary not a deep dive.