Transcript Slide 1

Revenue360 for QES version 13
Nick Davis & Jennifer Estes: Tuesday 8/20, 9-10 AM
Agenda
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Revenue360 for QES Overview & Demo
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Revenue360 Platform Overview
Address Validation
 Demographic Validation
 Insurance Eligibility Verification
 Pricing Estimation
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Benefits & Results
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Q&A
What’s the most complex job in
healthcare?
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The Challenge…
It takes me 2 years to train a registrar to
learn all they need to know …
…but they leave after 6 months!
Quote from a Director of Registration for an Ohio hospital
Get it Right the First Time!
AUTOMATES MANUAL PROCESSES - IMPROVES EFFICIENCY - REDUCES
COSTS AND BAD DEBT - INCREASES PRE-SERVICE CASH COLLECTIONS
Just In Time Knowledge Distribution
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The right
information
 To the right person
 At the right time
 In the right format
Computerized guidance ensures your best practice process is followed –
preventing many errors that lead to denials and rework
QES-Revenue360® Address Validation
QES-Revenue360® Address Validation
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Powered by USPS® Address Matching System &
Revenue360 Intelligent Guidance
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Integrated directly with QES (auto or manual)
Includes standalone AV option
Web-based, thin client response viewer
Uses facility defined business rules to:
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Verify if a Patient / Guarantor address is a valid existing address
Identify unknown or incomplete addresses for Demographic
Validation
Update Patient / Guarantor address to USPS standard
QES-Revenue360® Address Validation
Demonstration
QES-Revenue360® Address Validation
QES-Revenue360®
Demographic Validation
Why Validate Identity?
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Enhance patient identity management
Improve address input accuracy
Increase Self Pay collections
Decrease accounts sent to collections
Correct known bad addresses
Provide better patient care and outreach
Increase patient satisfaction
Red Flags regulation compliance
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fraud detection
Red Flags Requirements
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The FTC, the federal bank regulatory agencies, and
the NCUA have issued regulations (the Red Flags
Rules) requiring financial institutions and creditors to
develop and implement written identity theft
prevention programs, as part of the Fair and
Accurate Credit Transactions (FACT) Act of 2003.
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The programs must provide for the identification,
detection, and response to patterns, practices, or
specific activities – known as “red flags” – that could
indicate identity theft.
Red Flags Requirements
Types of Red Flags
• Alerts, notifications, or warnings from a consumer reporting
agency;
• Suspicious documents - drivers license, etc.
• Suspicious personally identifying information, such as a
suspicious address;
• Unusual use of – or suspicious activity relating to – a covered
account;
• Notices from customers, victims of identity theft, law
enforcement authorities, or other businesses about possible
identity theft in connection with covered accounts.
Revenue360® Demographic Validation
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Powered by USPS® AMS, Lexis Nexis® &
Revenue360 Intelligent Guidance
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Integrated directly with QES (manual)
Includes standalone DV option
Web-based, thin client response viewer
Uses facility defined business rules to:
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Confirm Patient/Guarantor address & demographic information
entered into QES
Identify and correct invalid Patient/Guarantor address &
demographic information
Locate unknown Patient/Guarantor address & demographic
information
QES-Revenue360®
Demographic Validation
Demonstration
QES-Revenue360®
Demographic Validation
Benefits of Address & Demographic
Validation
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Enhanced Eligibility match – higher clean claims
submission
Seamless Integration – no disruption to standard
process flow
Increased self-pay collection
Reduced third party collection and write-off expense
Decreased Cost associated with returned mail
Improved compliancy
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HIPAA
Red Flags Rule
QES-Revenue360®
Eligibility Verification
National Registration Errors
Most Common Errors
Service not
covered
Ineligible
Invalid Member
ID
Invalid Group #
No Pre-Auth
No
Referral
Why Verify Insurance Eligibility?
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To get the claim paid
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Identify critical information
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Make sure claim goes out clean
Reduce denials
Increase collections from payer and patient
Is there benefit coverage for the service
Copy, Deductible & Coinsurance responsibility
Will pre-authorization be required
Goal
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Maximize payment for services
Increase cash, lower AR Days, reduce rework & bad debt
QES-Revenue360®
Eligibility Verification
Demonstration
QES-Revenue360®
Eligibility Verification
The Response Summary simplifies interpreting benefit coverage and discrepancies of
what was returned from the insurance company
Eligibility – Response Summary
Only displays information returned
from payer that is different than what
you sent in the 270 request
Intelligent Guidance – notifies staff that insurance coverage was found for this
self-pay patient. Action instructions can be added.
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Eligibility – Full Response
The full 271 response is always just a
tab away so that all benefit coverage
information is easily accessible
Full Response is always available for reference now – or later in Billing Office
Eligibility – Out of Pocket Expenses
Co-insurance, Co-Pay and Deductible Tab simplifies identification and collection of patient
out-of-pocket expenses and can easily be exported to the Pricing Estimator
Eligibility – Worklists
Eligibility Worklists help manage workflow and find historical transactions
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Eligibility – Standalone Verification
Verify benefit coverage for
patients that show up in the
ED, clinics, physician offices,
radiology or anywhere they
walk-in to your facilities
Eligibility can be verified anywhere throughout the hospital outside of QES.
Patient account set up is not required.
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QES-Revenue360®
Pricing Estimation
Can you communicate the patients true
out-of-pocket cost?
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What will their insurance cover?
How much is the procedure?
What is their copay, deductible and coinsurance
responsibility?
Can you provide enough information to be credible
with the patient?
Is your staff capable of asking for the payment in a
consistent patient friendly manner.
What happens if the patient cannot pay?
Calculate patient total out-of-pocket cost
Three major components:
1. Charges (Adjudicated Claims)
2. Eligibility and Benefit Coverage
3. Insurance Contracts
Total Estimated Amount:
$759.72
Estimated Patient Amount: $389.07
Total Allowable Amount:
$445.33
QES-Revenue360®
Pricing Estimation Demonstration
Requesting a Price Estimation
When pricing estimate can be provided, “Send to Pricing Estimator” button
sends the eligibility response to the Pricing Estimation Module
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Auto-populates Patient Visit Information
Pricing Estimation auto-populates facility and patient information from eligibility module
Select Procedure (CPT / ICD) Codes
CPT Codes can be entered or staff can be guided to the correct code through incremental
text search
Auto-populates Benefit Information
from the Eligibility Response
Pricing Estimator auto-populates with the correct service co-pay, co-insurance and
deductible from the Eligibility Response
Simplified Accurate Estimates
Patient total out-of-pocket is instantly calculated and notes can be entered to be added
to the payment letter
Customized Letters
Customized, professional estimate letters can be printed, emailed, faxed and include your
healthcare system logo – payment remittance options can even be included to assist with
front-end collection efforts
QES-Revenue360®
Benefits & Results
Benefits of the Revenue360 Platform
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Guide your staff to make the right decisions for every
patient, every time…
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Error reduction – prevents common errors
Enforces compliance to your process
Allows staff to focus on patients instead of policies
Improves job performance, satisfaction & retention
Getting it right the 1st time gets the hospital paid faster!
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Make sure claims go out clean - reduce denials
Identify patients that need financial help from those who can pay
Maximize collections from both payer and patient
Increase cash, lower AR Days, reduce rework & bad debt
Actual Customer Results
BEFORE
AFTER
Total patient revenue
Increased point-of-service revenue
Decreased AR Days
Questions & Answers
THANK YOU!
For more information go to:
www.revenue360.net
Daily Session Evaluation Sheet
Giveaway
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Don’t forget to complete your Daily Session
Evaluation Sheet
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Return the completed form to the Registration Desk
at the end of each day to become eligible for:
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$100 Gift Card daily drawings
You are in Session CXX