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IMA Admin Update
Keeping Control of Billing
March 15, 2012
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Keeping Control of Billing
Keeping control of the billing process has become much more complicated in the shift to APG Billing. We have found breakdowns at numerous customers that had a significant effect on billing. These issues can come up in numerous functions such as:- Setting up the correct APG rate codes for services
- Making sure all billable services are being posted
- Using both the service and APG billing modules as needed for each payer and type of claim
- Using the IMA grouper to find claims needing re-billing and adjustments
- Confirming that claim files being submitted are being adjudicated by the payer
- Downloading and looking at 277 Claim status files
- Reviewing Remittance "R" errors
- Billing Suspense Management
- Denial management
- Resolving "D" status denials to move them to the next payer
- Using IMA lookup and reporting tools to keep "tabs" on the process
Please review your procedures carefully and if you think you need some help, please schedule a session with Barry Samel as soon as possible.
We would be happy to review your configuration and procedures to make sure everything is working smoothly.
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Enhancement and Changes
We have released numerous enhancement and changes to the billing modules in the last few weeks. Here are the details:- "Write-off": When posting a remittance for a service, the option to mark as "R=0" is being renamed to "Writeoff" to more clearly indicate that the denial is being accepted and the service will be written off or moved to the next payer (if there is one). This posting was previously called a "denial". We are working on updating the name in many different areas of the application. There is a new table named WRTOFF for writeoff reasons. Please make sure to add at least one entry to it (i.e. WO Writeoff).
- A new writeoff module has been added to display what services have been written off, when, and by whom.
- In service billing, the MB9 error has been removed by default. Instead, a count of services waiting for APG billing was added to the totals page
- The billing suspense management and denial management tools have been further enhanced to help manage suspense and denials
- The Medicaid eligibility module can be configured to recognize when a Managed Medicaid client has SSI and their MH services are carved out.
- Billing modifiers can be set to only be sent to Medicaid and not to other payers (i.e. Medicare is rejecting the U4 modifier)
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