PrimeCLAIMS

Frequently Asked Questions

• How does primeCLAIMS help with revenue cycle management?

  In addition to a claims clearinghouse and editor for skilled nursing facilities (SNFs), primeCLAIMS offers a comprehensive dashboard to track exactly where your reimbursement revenue stands. Putting this vital status data on the home screen helps managers monitor staff progress (or hang-ups) in the SNF claims revenue cycle, including secondary claims. The software also has a module to support SNF denial management, allowing end-to-end claims monitoring from a single system.

• What are the benefits of the primeCLAIMS dashboard?

  The primeCLAIMS dashboard provides a quick look at the status of all your SNF revenue claims that have not been completed, including secondary claims. It provides a summary of Medicare claims with information on claims that still need to be modified or denied.

• How is primeCLAIMS different?

  primeCLAIMS was built specifically for SNFs and post-acute facilities.

• How good is the support?

  Each person on the Support Team has more than 20 years of experience working with and in SNF revenue cycle management. They understand the daily process of preparing, submitting, and working claims from real experience.

• What vendors have you worked with to submit claims?

  primeCLAIMS is compatible with most of the EHR/EMR companies like PointClickCare, MatrixCare, American Health Tech, and many others.

• How many users can be added to primeCLAIMS?

  You can add an unlimited number of users.

• What are SNF claims?

  The Medicare Fee-for-Service Skilled Nursing Facility (SNF) claim file contains information from paid bills submitted by SNF institutional facility providers.  Skilled nursing care is the only level of nursing care that is covered by the Medicare program.

• How are SNF claims billed?

  The SNF Prospective Payment System (PPS) pays for all SNF Part A inpatient services. Part A payment is primarily based on the Resource Utilization Group (RUG) assigned to the beneficiary following required Minimum Data Set (MDS) 3.0 assessments.

• When Medicare is secondary, how does it pay?

  As a secondary payer, Medicare pays the lowest of the following amounts: (1) Excess of actual charge minus the primary payment: $175−120 = $55. (2) Amount Medicare would pay if the services were not covered by a primary payer:  80 × $125 = $100.

• How does primeCLAIMS handle SNF Secondary Claims?

  primeCLAIMS automates the SNF Secondary Claims so that in most cases you don’t need to print and mail claims to secondary payers.

• How long does it take to train someone on primeCLAIMS?

  The system is very intuitive and training can take as little as an hour.

• Can all users see all the information on the primeCLAIMS dashboard?

  No, users can be set up in this application using role-based security. Users can be set up to view on a need-to-know basis including the SNF Denial Management tool.

• How flexible is the dashboard?

  The primeCLAIMS dashboard allows you to move the data tiles and select the more important ones for you in your daily workflow for SNF revenue cycle management.

• When was primeCLAIMS first implemented?

  The first implementation as primeCLAIMS was in 2010. It was previously known as ProClaim Partners.

• What is revenue cycle billing?

  The revenue cycle is the series of processes around health care payments, from the time a patient makes an appointment to the time a service provider is paid-- and everything in between. One way to think of it remains in terms of the life cycle of medical costs.

• How is a SNF repaid?

  SNFs are repaid by Medicare Part A (healthcare facility or inpatient) or Medicare Part B (medical or outpatient), depending upon the status of the patient. The more knowledgeable services a patient requires, the greater the RUG, and the greater the reimbursement to the facility for inpatient services.

• Why is revenue cycle management important in health care?

  With revenue cycle management or RCM, healthcare providers guarantee they're appropriately and rapidly repaid for their services. While this is definitely advantageous to the supplier, it's similarly advantageous to the client.