Charge Receipt & Coordination
We kick off this process with the receipt of charges, which are logged into our ‘tracker module’. This module attaches a ‘unique’ system initiated number that will be permanently attached to a specific batch and each encounter there within. This unique number allows us to maintain audit controls and successfully track the life of a claim, while capturing and analyzing turnaround times between receipt of a charge and a claim submission.
Medi’s charge verification process begins with receipt of a charge batch. We then perform a thorough reconciliation of charges between the number of patients and a finalized (OR) / patient schedule.
Generally, turnaround time is dependent upon the provider’s mandated record completion protocols. Ideally, we require a minimum of three business days to generate a claim. However, depending on the volume, we can process charges within 24 hours from receipt.
Medi will utilize local CMS guidelines for coding and documentation review and other carrier’s regulations when applicable to an encounter. Accurate source documentation is integral to a practice’s compliance regulation, as well as maximizing and maintaining revenue viability. However, this process is dependent upon a clinician’s commitment to clear and concise documentation.
Workflow Management System ‘WMS”
The major contributing factor to ‘held’ charges is derived from the lag time of which it takes a provider to responsd to our request.The implementation of an EHR will eliminate deficient documentation by capturing all critical elements necessary to submit a ‘clean’ and compliant claim. However, charges that cannot be processed due to missing pertinent information and our anesthesia concurrency conflict will be returned to the client. Medi will utilize our Workflow Management System (WMS) to track, trend and report on deficient documentation. The method of communication is exchanged in a secure platform hosted on our internal security controls. The process will be implemented as follows:
- Create individual workflow access by provider to Medi’s secure system (unique user name and password) and access workflow directly on Medi’s WMS module
- Provider to access communicated issues with charts (with access to scan documentation as source reference, as well as easy amended record capture)
- Inputted data tracked by WMS for issue trending, response rate, response type, and turnaround time
- Develop ‘score card report’ by WMS
- Kick-off secure email notification to provider, designated facility staff, and Medi staff for management oversight
- Medi system notification when workflow is completed and ready for review by Medi coder
- Track and reported outstanding workflow based on ‘pre-determined’ notification sequence
- Validated changes are entered and submitted for payment
- Documentation Deficiency Reporting (DDR) available to HPA executive board members
- Document sharing via certified encrypted architecture