1. Clinical Claim Scrubbing Through Practice Insight

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

3. 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

4. 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!

5. 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)

6. Medicare E-Prescribing (eRx) Program – Adjustments
For % 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

7. 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?

8. 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”

9. Integration
Alpha II ClaimStaker
Practice Insight

10. a 1000 words!
is worth
A demo

11. 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

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

13. 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

14. 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

15. 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

16. 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