Florida Office of Rural Health Patient Financial Services/Billing Best Practices Presented By:

1. Florida Office of Rural Health Patient Financial Services/Billing Best Practices Presented By: Patrick Blech & John Leskiw Quadax, Inc.

2. Agenda

3. Who is Quadax? • Revenue cycle systems & services since 1973 (Clearinghouse) • Exclusively serving the Healthcare market • Privately held company, 600+ employees • 800+ clients in over 43 states • Client retention of 95%+ has been driven through true partnerships

4. HTH and Quadax Success • Southeastexpansion in October 2009 (office in GA) • Through our due diligence we learned about HTH • HTH previously used large publicly traded clearinghouses • Hospitals weren’t getting the support they needed • Service Model - Onsite implementation & continuing education • 30+ Hospitals in < 3 years (Georgia) • Currently implementing other hospitals in the SE (including Florida)

5. What is a Clearinghouse Electronic claims clearinghouses were devised by Medicare and insurance companies to step in electronically where the postal service was unable to – to act as air traffic controllers of electronic claim transmittal, so to speak, and prescreen for claim errors. Most simply, medical claim clearinghouses are aggregators (senders and receivers) of mountains of insurance claim information, almost all of which is managed by software. Large clearinghouses today process trillions of transactions each year. They are essentially 'regional' post-offices that enable healthcare practices to transmit electronic claims to insurance carriers. Additionally, they provide a Biller or Office Manager a place to manage all their claims from one central location --usually an online control panel, similar to online checking.

6. What is a Clearinghouse? HIS/PMS: Billing System Quadax Xpeditor – Claims Mgmt. Quadax Clearinghouse • Claims built - 837 or print image • Claims loaded from billing system and edited/scrubbed. • Clearinghouse picks up “clean claims” • Claim files “dropped” for editing “Errored” claims appear in workflow for correction & submission • Clearinghouse sends claims to payers Payers/Insurers • Medicare • Medicaid • Wellcare • Amerigroup • UHC • Others Remittance Advice Returned Or Denial

7. Claims Management & More… Many steps are involved in getting reimbursed:

8. Claims Management & More… Do More!

9. Valuable Reporting Comprehensive reporting enables you to manage your claims, not just transmit them Eliminate manual intervention & compilation of data

10. Valuable Reporting Aging Workflow Report

11. Valuable Reporting Batch Error Log Report

12. Continuing Education & Support

13. Continuing Education & Support • On Site Service Representative: • Work toward issue solution by assisting with: - Data placement on XP screens - Event creation/resolution - XpressBillers/Custom Converts • General review of claims in Selector • Reports – clean claim %, error reports • Largest $ & oldest claim in selector • Oldest claim in selector • Best practices & Product training On-Site service allows us to work hand-in-hand with your team to discuss better processes, challenges observed, and provide critical training – our service drives improvement.

14. Continuing Education & Support • Connections • Q-Tips • CANS • Service Reps • “White Papers” • Knowledge Base • Xpeditor Error Reports • EDI Tech & Client Set-up • Client Support Center • Edits & Documentation Team • XIT (Implementation Team)

15. Florida Office of Rural Health $1 Million Revenue Cycle Improvement - Elbert Presented By: Patrick Blech & John Leskiw Quadax, Inc.

16. Agenda

17. Claims ManagementX .. .. ..

18. Claims ManagementX • Powerful edit engine • Standard: LCD, NCD, CCI, OCE, MUE, RAC edits • Custom (client defined): written by Quadax developers, usually 48-hour turnaround (testing may require additional time) • Client-written: developed through the XpressBiller utility, an easy-to-use wizard .. .. ..

19. Remittance ManagementX .. .. ..

20. Denial ManagementX • Effective denial management strategy • Identify, Classify, Quantify • Manage Denial Follow-Up • Prevent Denials Through Process Improvement • Develop Effective Reporting Where do denials come from? Any and all points in the revenue cycle .. .. ..

21. Denial ManagementX Increased Organizational Accountability ‘Window’ into Denial Trend Data Using Current Xpeditor Reporting Tools Denial Inventory Management Tools for More Efficient Denial Response Robust Reporting Tool Set for Executive Level Management Delivered via ASP .. .. ..

22. DMX : Workflow Without technology…paper, time and work effort are wasted in manual processes Technology allows for denial capture, denial workflow, denial inventory management, and in some cases easy access to key documents a follow-up staff member would need. Denials will not go away and resubmission/appeals need to be done timely (or they may result in write-offs) RECOVER, RECOVER, RECOVER

23. DMX : Workflow Reduce black holes and inadvertent write-offs Increase staffing efficiencies and encourage process improvement Huge paper and time saver – decrease days in A/R

24. DMX : Workflow • Full/Line ID & Queuing • Flexible Worklist Set-up • Easy Access to Key Documents • Inventory Reporting & Dashboard • Tracking • Comment Upload ..

25. DMX : Workflow All data available with a click of a button: EOB’s, Appeal Letters, Claim… .. No more manual compilation of management reports – many available

26. DMX : Decision Support Without technology, data consolidation is difficult and excessively manual Technology allows for consistent reporting, data mining, data sharing and root cause analysis. There is too much data to handle manually and there are limited resources already at hospitals. Minimizing/preventing denials is one of the greatest opportunities a hospital has to improve cash flow and reduce write-offs. PREVENT, PREVENT, PREVENT – AT BATCH EDIT, PAYER REJECTION AND DENIAL LEVELS!

27. DMX : Decision Support Review Denials by Payer to Identify Trends – Payers Interpret ANSI Reason Codes Differently. You should also review similar reports at the Batch Edit and Payer Rejection Levels

28. DMX : Decision Support Drill Into Administrative Type Denials to Determine Root Cause and Implement Preventative Measures

29. DMX : Decision Support

30. Full suite of products to manage every kind of audit: RAC, MIC, etc. Preventive Edits DataXtract A Secure, web-based, hosted application Gives everyone on your RAC team easy access Axis™ for workflow, tracking, & reporting Integration with: AHA RACTrac, Human Arc, EHR Audit ControlX Axis .. .. ..