FQHC

Take control of eligibility and billing

As an FQHC you are challenged all the time with eligibility verification, RTP claims correction, extended A/R Days Sales Outstanding (DSO), and reimbursement write-offs. Keeping track of patient eligibility and fixing and re-submitting claims are a time-consuming, complicated process. All of this can mean delayed or lost revenue for your organization.

ABILITY services accelerate and simplify time-consuming reimbursement processes and can save you thousands of dollars.

What can we do for you?

ISSUE: I spend huge amounts of time tracking down all relevant eligibility

I spend huge amounts of time tracking down all the relevant eligibility info on a patient. Every single time, I have to access several sections of DDE to get a comprehensive picture. I have to go into all these portals and use a different login process for each payer. I keep a folder handy with all the different payers requirements.

ABILITY ANSWER: The ABILITY | COMPLETE service gives you a single, easy-to-use interface presented in a standard format regardless of payer or payer class. Sign in with one username and password to verify eligibility with Medicare, Medicaid, and over 400 commercial/private payers. You’ll get information on co-pays, termination dates, deductibles and coinsurance. Get rid of your sticky notes and increase efficiency and accuracy!

ISSUE: Looking up multiple patients and multiple payers takes forever

When I get a stack of referrals that need to be validated, I know it’s going to take forever to look up multiple patients and multiple payers. I’m always afraid I’m going to miss something when the process is so tedious and time-consuming to check every patient with every payer.

ABILITY ANSWER: Eliminate those long sessions and repetitive tasks! Using the simple ABILITY | COMPLETE interface you enter each patient (back to back), and with the click of a button send out a batch verification request for a single payer. Or, check one patient’s status with multiple payers, simultaneously. Or check multiple patients, with multiple payers! Think about the time you’ll be saving.

ISSUE: Re-validation is frustrating because status changes are so easy to miss…

Re-validation is another frustrating task, because changes in eligibility status are so easy to miss. I know it’s important to confirm insurance benefits periodically for our patients, but who knows how often to do it? If we miss a change, it can delay reimbursements and really mess up our patients’ bills.

ABILITY ANSWER: With ABILITY | COMPLETE you can set up automated sweeps that check the eligibility of your entire patient census, giving you status alerts when coverage changes or switches to non-eligibility. You also receive alerts with visual cues for failed eligibility or other follow-up items that need attention. Bill the correct payer the first time!

ISSUE: When claims get denied, it’s so difficult to prove previous verification…

When claims get denied and we need to appeal, too many times we can’t prove a patient’s eligibility was previously verified. We often need to produce historical insurance verification when challenged by Medicaid, Medicare or a commercial payer — for patients we’ve already provided service for — and there’s no easy way to do it.

ABILITY ANSWER: ABILITY | COMPLETE stores all validation transactions for historical proof of eligibility status. Staff can pull up all historical insurance verification transactions (time and date stamped) by simply running an electronic report from their desktop. You get fast, accurate documentation — proof that eligibility was verified, and confirmation of coverage — all in one easy-to-produce report.

ISSUE: Our biller has to manually search for and identify claims problems…

Our biller has to manually search for and identify claims problems. Correcting them takes a lot of effort — she walked me through the process and it’s a nightmare! All of that can cause delays in getting our reimbursement, because claims needing to be fixed are missed or aren’t identified right away.

ABILITY ANSWER: With ABILITY | EASE billing staff gets automated alerts, reports, and inquiries for ALL claims submitted to Medicare, sent right to their desktops. They’ll see whether the claims are paid, suspended, RTP’d, rejected, denied, or need modifications. Pop-ups on the reports explain the problem in detail so the corrective action is clearly identified — no need to refer to external resources.

The biller then uses a simple “click to fix” option from a “Windows-style” interface to correct and resubmit claims — all without having to access the multiple, complex “green screens” of the DDE/FISS system.

ISSUE: I’d love to get a better handle on cash flow…

I’d love to get a better handle on reimbursement cash flow projection for our Medicare claims, but it seems almost impossible with our current setup.

ABILITY ANSWER: With ABILITY | EASE, you have access to comprehensive Medicare claim reimbursement information daily, with reports that provide a view of all claims paid as well as reimbursements expected (for up to 14 days in the future) and claims in process. You can eliminate the limited visibility regarding Medicare reimbursement and the risk of not knowing your cash flow position.

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Questions? Comments? We’re here to help!

888.895.2649