Revenue Radio: Optimizing clearinghouse data

Episode 8 December 02, 2022 00:14:59
Revenue Radio: Optimizing clearinghouse data
Kassouf Podcast Network
Revenue Radio: Optimizing clearinghouse data

Dec 02 2022 | 00:14:59

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Hosted By

Tara Arrington

Show Notes

Kassouf Healthcare Solutions's Revenue Radio gives practice managers the tools you need to run a successful and profitable medical practice. Your host, Kassouf Healthcare Solutions Executive Director Jeff Dance, discusses the opportunities and challenges related to the business side of medicine. 

This episode is an excerpt from Kassouf and Kassouf Healthcare Solutions's recent workshop, Healthcare Headlines, which covered healthcare's most timely topics. Kassouf Healthcare Advisor Stewart Garner shares tips to maximize clearinghouse data. Stewart discusses various tools, dashboards, and reports that clearinghouses provide, best practices, and action items for medical practices. 

Founded in 1981, Kassouf Healthcare Solutions was created to handle the business side of medicine, allowing doctors to focus on their patients. The Kassouf Healthcare Solutions team is comprised of operations management and revenue cycle specialists. We enhance the business of medicine by providing value to our clients with an action-oriented and caring customer-centered focus. Learn more here. 

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Episode Transcript

Speaker 1 00:00:03 Hello, and welcome to our Revenue Radio, powered by caso and Caso Healthcare Solutions, where we enhance the business of medicine. Speaker 2 00:00:14 Today's episode of Revenue Radio is an excerpt from our recent event, healthcare Headlines. Today you'll hear from Healthcare Advisor Stewart Garner, as he discusses clearinghouse data and how you can maximize this data to benefit your practice. Thanks for listening. Speaker 3 00:00:32 Just setting the stage really quickly about why we thought this was a value. Uh, health healthcare advisors on my team, several of us go to various practices throughout the year, health systems, hospitals, all types of organizations. Uh, and many of those projects are revenue cycle management focused. And some of the things we always ask, we're looking to are clearinghouse related. You know, we may ask for access, uh, we may ask for data, uh, some general questions, things like that. And I think too often, some of these key resources we work with, high level folks don't know where the clearinghouse is. They don't have access, they don't know what data's there. And as we'll talk about some of the clearinghouses we, we have exposure to have worked with before, have some pretty great tools that I think your RCM teams, uh, could be taking advantage of if they're not already. Speaker 3 00:01:20 So hopefully, uh, for those of you who are already fully aware of what you guys had with your clearinghouse and are using those as often as you should, maybe pick up a new tip or two. But for those who aren't aware, hopefully you guys take us back to your office and can use this to more, uh, maximize your revenue cycle performance. Uh, as far as a few things we'll cover today, uh, in a session that certainly warrants more than 15 minutes, we'll look at a few tools. Some of the, some of the clearinghouses we think are, are pretty good, um, dashboards, reports, things like that. Uh, we'll highlight really quickly best practices in terms of maybe how often different people on your team should look to use the clearinghouse and how they can use it. Uh, and then a few action items for those of you, um, in attendance. Speaker 3 00:02:01 So, first things first, you can't have a good presentation without some sort of disclaimer. Uh, not all clearinghouses, excuse me, are equal. Um, they're not all the same. Some are great, some aren't. Uh, some have separate websites where you actually have to have a username and password others to access them there as an actual button or icon embedded in your practice management software. So it's very important, especially as we start talking about some of these reports, some of these dashboards that you guys are fully confident in how you understand these things work. A couple of examples. Some of these reports that are date range based may be a data service range, you may think as a data service range, but it's really more of a transaction date. So September 1st of September 30th may actually be all of the rejections that occurred on those dates. And you may log in for the first time and see, oh my gosh, we've got a hundred rejections from two months ago. Speaker 3 00:02:51 Maybe that number's locked in time because it's actually when that rejection occurred. They may not be outstanding, if that makes sense. But it's also important that you guys understand how those lists are refreshed or updated. Some of the clearinghouses we work with, you have to manually clear them on the clearinghouse yourself. Others, when you recall it through your practice management software, it refreshes the list, takes it off so you don't have to do kind of double work. Uh, so you wanna make sure you're familiar with how you work. Particular clearinghouse works. All right. So first we're gonna do a little bit of a clearinghouse exploration as, as I titled it here. Um, some of the higher quality portals we work with have some are all of the following. So an informative summary page. Uh, some of these insightful dashboards. I've actually got some pictures we'll look at here in a second. Speaker 3 00:03:35 Lots of different reporting options, filtering all that good stuff. And perhaps most importantly, they're, they're user friendly, they're simple, easy to figure out. The good ones, have some, are all of these, um, I may have broken presenter 1 0 1 rules, uh, with including a bunch of images in here. But I thought, you know, bullets words are great. I think perhaps maybe in support of some of the things I'm trying to drive home here. I think graphs, good images in some ways are more effective in communicating the message. So I did look at these on my, my computer and they looked clear to me. I hope, hope they're clear to the folks online and here in person. Um, at the very least, when you get copies of these slides, you should be able to zoom in and kind of see what I'm, see what I'm highlighting here. Speaker 3 00:04:17 So one example of a, a quality summary page here that we pulled from some clearinghouses, we have access to right away. You can see how you're doing from a report card standpoint in terms of how many errors you have, uh, by by month. So in this example, something happened in January, February and April, uh, or March rather, we're back down. You can kind of see how things are spiking. Um, and as we look through these, I want you to think about your practice management software as well. Some of them are also not equal, right? Some of these don't have good reporting. Don't have an easy way to get the data you need. You have to export it, manipulate it, send to one of Joni's data nerds to get a good, nice graph, all this stuff. So in a lot of ways, the clearinghouse can provide that for you. Speaker 3 00:04:59 And I can think of at least one software where I would turn to the clearinghouse for this type of data before I would try to pull something out of the PM system. Uh, in terms of insightful dashboards, this is actually kind of both. It's actually a summary page for the, uh, prime suite, uh, Greenway Clearinghouse. You can customize this to your liking as you can with many of the clearinghouses. So in this case, all of these separate, um, sections, I'll call them where there's claims management. Then I'll write by payer summary of rejected claims. This is what our username has set to our access that we want to see as soon as we log in, the date ranges are locked and we can change them. But all I have to do is hit that little refresh, uh, square there and the data updates as soon as I log in. Speaker 3 00:05:40 And I can see really quickly what my top claim rejections were for maybe the last month, last three months. Uh, denial rates by payer. I think Austin, I'm probably guilty of this too, when we talk about clearinghouses, we think rejections, but the good ones can pull back denial information as well that you're getting on your remittances that are also flowing through your clearinghouse. Um, all of these things help you to trend over time, right? And again, circling back to some of these, I'm not gonna say names, practice management systems in my head, it's really difficult for your team to be able to capture all of that revenue that's just hanging out there that maybe fell through the cracks, maybe had some turnover, and it was a Blue Cross person, and there was an issue four months ago and it never got back to being cleaned up. Speaker 3 00:06:22 You don't know where the claims are, what the issues were. I mean, you can use a lot of these dashboards to help capture some of that revenue that's, that's hanging out there. And it's is soon to be, um, past the timely filing limit. Another example of a, a dashboard or, uh, metrics I pulled at, at very quick, easy glimpse. You can see how well you did during the month. Uh, I'm sure all of you're tracking revenues, reimbursements, adjustments, all these things. And probably by payer as well. So you can see pretty quickly that, uh, at this particular month I pulled, here's how much we had in claims. How many of were they more accepted? How many of the total rejections were all that stuff? And then of course, not pictured here, a lot of these clearinghouses that let you drill down into those high level statistics as as needed. Speaker 3 00:07:08 So if you see an issue you wanna circle back to and see what's going on, you can drill further and further and further. You don't have to be in the weeds unless, unless you need to. A couple other examples here, uh, I wanna highlight. Um, again, graphs I think are a much easier way to see what's going on than bullet points. And sometimes just, uh, casual conversation. And this example on the left as far as how many claims were rejected in the orange, you can see how this group, uh, was doing all the way from January to September. Uh, it looks like they made some improvements from July through, uh, September as well with what I hope was in response to looking at this data and seeing, okay, where are our issues? How can we prevent them up front? Um, for all of us who live and breathe revenue cycle management, I think prevention has gotta be one of the first words we think about when we think about how we play that game. Speaker 3 00:07:59 So these reports can show you as the one on the left does, for example, top rejections from the month of September, what our top recurring issues are. Uh, in this case it looks like, um, at least maybe not on this one. And some of these here, you'll see some reasons related to eligibility. That's a front desk issue. Uh, maybe it's a breakdown before then. Um, maybe it's with the same payer, maybe it's with the same person. You know, you can take this information, find the issue, find a way to prevent it, and then the claims come in, are out cleaner, come back, pays faster, which again, is kind of the name of the game that we play. Um, on the right top 10 denial codes, again, I, I think we think of rejections too often when we think about a clearinghouses, we try to pull denial information from the software itself, the practice management system. Speaker 3 00:08:44 And it's not as easy to do depending on how you're posting that information in your software. There are a ton of factors that can make some of those reports. Either not pull anything, not accurate, all that stuff. And then, then of course, heaven forbid we have a payment poster who's kind of manually changing things around and not maybe including something that was reported at the clearinghouse level. Uh, reporting options. So another feature of the clearinghouses that are of high quality is you can actually pull customer reports yourself, uh, depending on what you want. So in this case, I just pulled a simple screenshot of, um, uh, total rejections for the month of September, uh, by payer name. I could have sorted by a couple other options. Um, and then you can see by reason what's going on. So we had some, again, issues, it looks like due to, uh, eligibility, uh, entity, not eligible for benefits. Speaker 3 00:09:31 All these common denials that we all see over and over, um, that are somewhat avoidable, but we can improve. Um, another thing I wanted to highlight that is the future of many of these clearinghouses. In the top right there is a printer icon and an Excel icon. Many of these clearinghouses allow you to export this information. So if you have a data nerd in your office like Joanie, or I'd like to say I'm a data nerd, probably not as good at it, uh, as Joni is. But, uh, you can export to Excel, you can manipulate it further and kind of customize it if there is some sort of limitation with what you want from the software you're using. So, uh, it's not stuck on the screens. You don't have to take a screenshot and put yourself at risk for some sort of blurry, uh, image, uh, like I may have. Speaker 3 00:10:14 But you can export, you can print a pdf, all this good stuff. And again, you may think that your team is aware of all this information and okay, we're definitely looking at, we know what's going on, but I think it's probably worth checking, uh, which you'll see. I recommend at the end just to make sure that you're maximizing what you guys have available. A few other report options. I think this is from the NextGen clearinghouse actually, uh, that I thought were of, of value total payments by payer. I know we all look for those Blue cross checks, those Alabama Medicaid checks that come basically at the same time on a recurring schedule. Uh, it's a, it's a quick, easy way to see, um, maybe graphically or another perspective how those payments have changed over time. Hopefully catching an issue immediately rather than 30, 60 days later. Uh, we always want to catch these things up front too, right? Um, and then payments by provider, all that good stuff. There's a ton of reports out there on this, this particular clearinghouse. Speaker 3 00:11:11 I'll pause for a second here. All right. Um, a couple of things. In terms of best practices, I think first and foremost, you have to log in to use your clearinghouse, right? You have to access it, click it maybe is another way to say that depending on how you have access to your, your particular clearinghouse. But I think depending on how robust your practice management system is, if you have a fantastic software, you've got all these reports already queued and it fits out all this great good looking data, then you may not want to use it as much. You may not need to. Uh, but I would say sometime at least maybe daily to weekly, your, your billers should be looking at this. Somebody should be looking at the clearinghouse information to see how do we do, how do the claims go out yesterday, right? Speaker 3 00:11:55 If you're submitting claims every day, you wanna make sure they made it. There's no hiccup in the process. Cuz the last thing you wanna do is wait until, you know, August, uh, October 30th when you're doing in a month and say, oh, wait a second. You know what, what happened? Right? Uh, and then managers, I put weekly to monthly. You know, this, this obviously can change depending on your organization, how often you think you need to look at it, but I think every level in that department needs to look at the information on the clearinghouse at some point on a recurring schedule. Uh, the second thing you can do to maximize your clearinghouse is you can customize these dashboards. You can save these report filters, just like I said, with that image of the Greenway Prime Suite clearinghouse. You can customize that so when you log in, you don't have to redo it. Speaker 3 00:12:37 You can save time. Uh, and you can even take advantage of some other automation where you're sending reports from the clearinghouse to you in some cases. So you don't have to log in. You can schedule it to push to you Excel, pdf, what have you, uh, and kind of make, you know, make use of that, that technology that's available. Uh, the last thing I'd recommend, if you're not already doing it, is incorporate a high level, at least a high level review of this type of information during the end of month process. Uh, so you can see how you're trending over time. Again, that's a big part of what we do in revenue cycle management. Some of these graphs, these good pictures, these good images are available to you. You don't have to reinvent the wheel. Uh, if you have one of these, you know, these clear counsels. Speaker 3 00:13:19 All right, so action items. I think I'm gonna make it. Uh, first thing I would say to ask your billing team when you get back, um, you know, where's the clearinghouse? Can you, can you show me what, what things look like? Do you have access to it? Uh, how, how often do you log in, check to make sure that your team is, is using it, uh, and explore it. Figure out what options you have available. Maybe you have a poorer performing clearinghouse in terms of technology, but maybe you have a really good one, you're not taking advantage of it. Um, going back to my point about how important it is that you understand how it works, you certainly don't want to misinterpret what the data is. If you need training, figure out how to get it. Some of these, um, vendors have online classes, recorded videos, pdf, things that can make you dangerous, you know, in a good way. Speaker 3 00:14:05 You know, um, or you can ask questions to those you know, who use the same software and may have expertise to share. Uh, and then establish a regular recurring schedule, uh, utilization, again, both at biller and management levels. And lastly, if you aren't already tracked some of these metrics that most clearinghouses provide first pass rate or, or clean claims, the number of outstanding rejections, uh, total number of claims, how much money that is, what payers are tied to. And then you start again, going down in, in detail depending on what the issues are, uh, and trend that over time. And that's it for Speaker 1 00:14:41 Me. This is Jeff Dance, uh, executive director at CASO Healthcare Solutions. Uh, we, uh, are glad that you're on our revenue radio that's powered by CASO and Caso Healthcare Solutions, where we enhance the business of medicine. Thank you and have a great day.

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