Clinical Claim Scrubbing Through Practice Insight

Why implement a claim scrubber? What makes a claim scrubber so important? Why should you include claim scrubbing in your total claim management sale?

What makes a claim scrubber so important? Reduce denials It costs up to $25 to resubmit a claim* Optimize reimbursement The average monthly underpayment is $889* Considering the current economic environment, you can’t afford not to use a claim scrubber! * Source - AMA

Insurance companies are getting better at NOT paying claims! National Correct Coding Initiative (CCI) Medically Unlikely Edits (MUEs) Carrier/FI/MAC Medical Review (MR) Recovery Audit Contractor (RAC) Comprehensive Error Rate Testing (CERT) Increased introduction of quality initiative programs like PQRS and eRx!

Medicare Physician Quality Reporting System (PQRS) Beginning January 1, 2013, any eligible provider not participating in the PQRS program will receive a 1.5% reduction in Medicare payments beginning in 2015 Enrollment in the Maintenance of Certification (MOC) program incentive qualifies physicians for an additional .5% incentive payment Medicare Physician Quality Reporting System (PQRS)

Medicare E-Prescribing (eRx) Program – Adjustments For 2013 1.5% payment adjustments apply to any EP or group who did not participate in the E-Prescribing program in 2011 To avoid the 2014 eRx payment adjustment, individual EPs must have either: Been a successful electronic prescriber in 2012 Reported the G8553 code via claims for at least ten billable MPFSDB services provided from January 1 through June 30, 2013 Medicare E-Prescribing (eRx) Program – Incentives The 2013 incentive payment is .5%. This is the last year of incentives for this program! Successful electronic prescribers who also have at least 10% of their MPFSDB charges comprised of the codes in the denominator of the measure for the reporting period (January 1 through December 31, 2013) will be considered incentive eligible

What types of edits do we offer? Physicians Quality Reporting System (PQRS) E-Prescribe Correct Coding Initiative (CCI) CPT, ICD, and modifier Date Demographics Evaluation and Management (E/M) Medical Necessity (LCD/NCD, FL Medicaid, commercial, proprietary) POS Provider Reimbursement Units What types of edits do we offer?

Customizable Accounts preconfigured per provider specialty specified during registration Scrubs both institutional and professional claims Edits can be configured by claim type Custom edits can be created with an advanced “edit wizard”

Integration Alpha II ClaimStaker Practice Insight

a 1000 words! is worth A demo

ClaimStaker works seamlessly with the Practice Insight software Claims are created and then scrubbed within Practice Insight, allowing the customer to correct claims immediately before sending to the payer Edits can be viewed as a single claim or as an easy-to-read batch report Clear and concise edit messages make it easy for providers to correct claims Claims that do not need correction can be set to “Ready” status and sent to the payer Updates are done behind the scenes with no disruption to the user ClaimStaker works seamlessly with the Practice Insight software

Different registration options to meet the needs of your customers Demo mode Trial mode Go Live mode

Registration options – Demo Provides a free one-time file scrub Uses a live claim file from the customer Shows the customer how they will benefit from using the claim scrubber Alpha II/Practice Insight may assist in the demo with your client Review the report and show it to client during the demo File can be sent to customer after the demo Demo Mode

Registration options – Trial Perfect for customers who are still undecided Allows customers to scrub 100 claims per registered provider free of charge (i.e., 5 providers can scrub 500 claims) Customers participate in a training session to familiarize them with clinical claims scrubbing We assist with training your customers Should only be used for interested or large provider groups Trial Mode

Registration options – Go Live Customer is ready to start claim scrubbing This is the billable mode Customer participates in a training session to familiarize them with using clinical claims scrubbing Assistance with training your first customer Go Live Mode

Alpha II ClaimStaker will help your practice… Eliminate the need to re-file claims Reduce rejections Increase payments Eliminate claims review processes Reduce denials Always use proper modifiers Always sequence codes by highest RVU Eliminate over-coding and under-coding Check CPT/ICD-9 combos to ensure medical necessity Ensure accurate/optimal reimbursement