We enjoyed serving as a host to this exciting event and the many great connections along the way. If you missed our participation in the "50 Shades of Data: Your Most Under-Leveraged Asset" panel, stay tuned to news! 

We'll soon follow with a revisit of these best practices for mining/integrating data to affect care delivery, procurement, human capital, managed care, bundling and risk. Thanks to Quantum Age, Vintage Senior Living, Cardon & Associates, Mix Solutions and our VP of Technical Services Russ Hertzberg, for making this panel a success.

You also may have heard about our PBJ solution – visit www.primecaretech.com/PBJReporting to learn more. If we didn't get a chance to catch up...

Normally, our blogs address either high-level views of revenue cycle management with an emphasis on billing automation. Or we get into the nitty-gritty of how-to’s for those who either prepare and submit the claims or supervise those who do. What we have discovered, though, among our contacts and clients from the C-Suite to the billing office is that many have asked us, “What is the cloud?” Haven’t you used a word almost all your life, but have never really looked up its definition? Then one day, you find yourself using the word in a conversation only to question your understanding and use of the word. Well, one of those words, we’ve discovered, is the “cloud”. So let’s give you a very quick and stratospheric overview. Here goes.

What is the cloud?

Never mind the distracting diagrams of arrows pointing to or away from a line rendering of cloud-to-computer relationships. (Disclaimer – there are several definitions of the cloud, but for our purposes, we’ll limit it to Software-as-a-Service or SaaS.) In this case, the applications and data you use reside somewhere other than in your computer or on your company’s network. Instead you access these as a service over the Internet. Hence, SaaS. They are located somewhere in the “cloud”. When you “Google” something, you are using the cloud. Are you a TurboTax customer? Likely you prepared and filed your taxes on line. That was the cloud. Have you purchased or sold anything on eBay? That was the cloud. You don’t know where exactly the servers containing the application and your data or transactions reside, but they are out there in a secure data center environment.

Why the cloud?

Simply put, someone else is managing the service for you. You don’t need to build, staff, manage hardware and software licenses, upgrade, and fix. You leave the job to someone else while you focus on what you need to do without unnecessary distractions. You also only use as much of the service as you need.

It’s like a utility. You pay for it on demand, such as the TurboTax example, or on a subscription basis, like our primeCLAIMS application.

No hassles for you. The application and your data are accessible anytime from anywhere you have a secure connection to the Internet.

What does that mean to Revenue Cycle Managers?

Revenue Cycle Management is complicated enough without worrying about and hassling with the hardware and software needed to prepare, process, submit, and monitor your claims until payment arrives. Using the cloud is simple. You focus only on the revenue collecting tasks at hand and what clearinghouse provides the best solution to meet your needs.

Summary

The cloud has revolutionized how you can monitor and manage claims through a clearinghouse. It speeds up the process, making the process practically transparent. It’s a win-win for all concerned. Just choose carefully. It just make cents.

In March and April, we posted Payroll-Based Journal (PBJ)-related blogs to help our readers further understand and prepare for what the Centers for Medicare and Medicaid Services (CMS) will require of them starting July 1^st. In this posting, we’ll take PBJ reporting one step further. But first, we assume you are not inclined to create your own system to input the necessary data and compile it into an XML file. If this describes your situation, then you will need to contract with a vendor to help you automate the process. And we think doing so is well worth the time, effort, and money.

Quick PBJ summary

But first, at a high level, let’s rehash information found in previous blogs about PBJ reporting. In our blog, dated March 15, 2016, we encouraged providers to get started now. Why?

• Submission will be mandatory, effective July 1, 2016. Providers will be required to file both staffing and census data no later than 45 days after the last day of each fiscal quarter (i.e. for the quarter ended September 30, 2016 electronic reporting must be completed no later than 11:59 pm EST on November 14, 2016).
• Every quarter, providers must use the online PBJ system provided by CMS to report the hours staff – AND contractors – were paid to perform onsite services for facility residents, excluding paid time off (e.g., vacation, sick leave, etc.).
• The PBJ system will only allow XML file submission – one per facility – and/or manual data entry at this time.

We warned, “Don’t be lulled by the November 14 3^rd quarter reporting deadline. Collecting this data and preparing it for submission will take time – lots of time (and money) – especially if you are trying to do this manually.” It’s expensive and prone to clerical errors. Automate as much as possible by contracting with a vendor that offers PBJ reporting automation.

Even automated solutions will require some manual data entry

Please be aware that no matter how automated the system is that you select, there will still be a need for some manual data entry particularly for those direct care staff whose time your time and attendance application may not capture sufficient to meet PBJ requirements, such as:

• Salaried and corporate staff
• Contract workers
• Staff who may wear different hats throughout the shift
• Staff attending a training or inservice session
• Exempt nursing staff filling in for a call-in floor nurse
• Allocating hours for the 3^rd shift accountable over a two-day period
• Splitting hours between the certified and non-certified sections or for those facilities with certified residents housed in a facility that does not have a distinct part

Engaging a PBJ reporting solutions vendor

Determine the features each solution offers and confirm that they have been sufficiently tested. For example, is the solution able to?

• Integrate cross-facility data from employee and census systems
• Allow providers to manually enter and append contractor data to the existing file
• Enable providers to view/monitor a summary of employee and contractor hours
• Automate mapping of labor codes to CMS codes
• Retrieve multiple XML files
• Export one all-inclusive XML file per facility for quarterly upload to CMS

There is still time, though short now. Look at offerings, check their features, confirm their compatibility with your organization's intended best practices, check references, and confirm. Then execute and test, test, and test. Don't cut corners.  

If you would like a no-obligation demonstration of our tested PBJ Reporting Platform, call 877-644-2306, or click here to request a demo.

FYI - Here’s a valuable PBJ summary document - https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-16-13.pdf

“By adopting a platform now, they can assure all systems are in place and run test submissions to assure they're in good shape prior to the deadline,” said Jim Hoey, president of Prime Care Technologies.

Revenue Cycle Management is constant, a year-round effort, but periodically worth occasional scrutiny and cleaning up. Likewise, if you bill Medicare for services and need to file secondary claims, then taking a look again at automation through a clearinghouse may result in cleaning up those outstanding AR balances. This month’s blogs offer useful insights to help AR managers refresh revenue cycle best practices and remove the clutter of uncollected revenue.  

Spring clean your revenue cycle

This is the time of year to open the windows, air out the house, deep clean long neglected spaces, and tidy up. For AR managers, it’s also a good time to “spring clean” the revenue cycle in a few key ways.

1. Update and refresh your payers’ contracts “wiki”.
2. Check the aging.
3. Revisit your pre-admission screening procedures.
4. Make sure the census is correct.
5. Stay on top of your Days Sales Outstanding (DSO).
6. Conduct a thorough claims triple check.
7. Engage the right clearinghouse.

Learn how these steps can help you freshen up your revenue cycle management practices.

Secondary payer claims – finding ROI (Reducing Outstanding Income)

The ROI of automating secondary claims through a claims clearinghouse is potentially huge. Traditionally billers completed paper forms and mailed them to the payer. Sounds simple, but it wasn’t and, some providers are still submitting claims in this way. Phone calls and error-generated resubmittals contribute to a complex, cumbersome, costly, and prolonged payment process. With electronic claims automation, providers can securely submit and track claims to multiple payers all in one portal. In this blog, we highlight some of the advantages a claims clearinghouse can offer and the potential ROI when doing so.

Discover the benefits and ROI of automating secondary claims submission. 

Are you collecting all your secondary claims and
how much does it cost to do so?

Check it out!