 |
|
Process
Once we have received all of the required information, this is what you can expect:
Qualification Process:
Once the remote access has been established, and we have received the discharge list, we will begin qualification procedures. The qualification process consists of making sure the account is a charge based payer and has been paid at least 50% by the insurance company;
also, that the account is not involved in litigation or covered under any prompt pay discount agreements. We will not review any self-pay accounts. At this time we will need to obtain copies of the original UB and Itemized Bill for each account to be reviewed. (This UB and Itemized Bill should contain all charges, including corrected charges, which have previously been billed to the insurer.) This process can be completed via remote, or by a clerical person on site at the hospital.
At this point the project coordinator will schedule the beginning of the on-site review. This usually occurs within four weeks after we have received the discharge list and remote access. Our Nurse Consultant usually sits within the Medical Records area or any area that you designate. Our Nurse Consultant will require the complete Medical Record for each account to be reviewed. It is helpful for the Nurse Consultant to have phone and computer access. The project coordinator will work directly with the hospital's Medical Records Director to coordinate the pulling of the needed Medical Records.
Ample time is allotted for this procedure. Once the review has been completed, any re-bill accounts will be sent directly to the proper insurance address by our staff.
Collections Process:
Our collection specialists immediately begin efforts to bring the account to resolution. They will aggressively pursue all payments.
Reports Package:
At the conclusion of each month throughout the project, we will electronically send our monthly reporting package. The reports will identify the stage of the project at each given month. Reports included are:
- Project Summary - A brief summary of our project recovery.
Listed on this report are:
- Total number of accounts reviewed along with the Total Dollar amount reviewed
- Total number of accounts rebilled, along with Total Dollar amount rebilled
- The percentage of accounts that were rebilled versus reviewed. Please note this percentage is based on actual dollars rebilled. It is not based on number of accounts with errors.
- Total number of accounts collected and Total dollar collected. This number will change each month as we continue with collection on these accounts.
- Billing Summary Report - This lists in alphabetical order the accounts that have been rebilled to the insurance company. This will be a running list of all the OPEN accounts.
- Statistical Summary Report - This is a cumulative report covering both Inpatient accounts and Same Day Surgery accounts.
- The first page of this report summarizes by department, the number and dollar amount of undercharges, debits, credits, overcharges and undocumented errors identified during our review. (A Credit (-) and a Debit (+) is an item that was incorrectly charged. For example, a patient was in ICU, but was charged the regular room rate. The regular rate would be credited to the bill and the ICU rate would be debited. For every single credit there must be a corresponding debit. In essence we are rebilling the positive net difference between the two charges.)
- The second section of the Statistical Summary Report lists each department separately,
identifying by item number and item description the errors located for that specific department.
- Department Edit Report - This report lists by department the patient name and account number on which each error occurred.
|
|
