ERA Manager Implementation - Practice Insight

ERA Manager Implementation Andrea Frost

Agenda • • • • • •

Populate ERA Data Utility ERA Manager Demo Setting up a customer for ERA Manager Training your customer on ERA Manager ERA Manager and Task Manager Integration ERA Manager Follow up

Medical Office Workflow Patient appointment scheduled

Patient seen by Physician

Claim created in Practice Management Software

Insurance Payor pays claim

Claim adjudicated by Insurance Payor

Claim billed to Insurance Payer

Physician bills patient

Medical Office Workflow Patient appointment scheduled

Underpaid, Denials Insurance Payor pays claim

Physician bills patient

Patient seen by Physician

Claim created in Practice Management Software

Rejections

Claim adjudicated by Insurance Payor

Claim billed to Insurance Payer

Medical Office Workflow Patient appointment scheduled

Claim created in Practice Management Software

Patient seen by Physician

ERA Manager Insurance Payor pays claim

Physician bills patient

Claim Manager Claim adjudicated by Insurance Payor

Claim billed to Insurance Payer

Populate ERA Data Utility Step 1

Populate ERA Data Utility Step 2

Steps to Demo ERA Manager Preparation • Populate customer’s ERA data • Preparation – Analysis by Reason and Procedure Code • Look for Claim Adjustment Codes they would want to refile – 125: Payment Adjusted due to Billing submission error – 16: Claim lacks information needed for adjudication

– Manage Expects Table • Look for Procedure Codes being billed at allowed amount • Compare amounts look for huge deltas

ERA Manager Demo • • • • • • •

Overview of ERA Manager Transaction ERA Manager-middle section Reason Analysis Report Reason/ Group Code Filters Working ERA Transactions Follow-up status/ Assigned Staff Filters Top 10 Denial Analysis Report

ERA Manager Customer Training Preparation • Setup Customer for ERA Manager prior to customer training • Setup staff members for ERA Manager • Export the Reason Code by Procedure Report and have office administrator review prior to training

Customer Training • Make sure customer understands the purpose of ERA Manager • 4 Parts to train in ERA Manager – ERA Manager main screen – Analysis Reports – Manage Expects – Task Manager Integration

Main points to train on • •

• • • •

Provides detailed view of all ERA Transactions in an ERA files. Detailed view includes: charge amount, amount paid, allowed amount, Claim Group and Adjustment codes. Provides customers the ability to sort ERA transactions by CPT code, Check number, Payer, Claims Adjustment Group and Claim Adjustment Reason Code and Status. Allows customers to view ERA transactions by status, including Denied ERA Transactions. The Denial Screen allows staff members to add notes while working denials that will be attached to the era transaction. Staff Members can also add a follow-up status to the ERA transaction such as Paid, Appealed, etc. Analysis reports provide data such as break down of CPT codes that were denied for a Claim Adjustment Group Codes and Reason Code. All ERA data is stored in Expects Table. The table stores CPT code with modifier, charge amount, allowed amount, and expected paid amount. Customers can use this table to see if they are over/under billing an insurance company and compare allowed amounts.

ERA Manager Main Screen Tips for Training • If claim # equals 0 claim could not be found • ERA Manager is ERA Transaction and can be multiple transactions per claim • Status does not change as it is from the payer on the ERA • All claim follow-up and editing functionality is available in ERA Manager

Analysis Reports Tips for Training • List all Claim Adjustment Reason codes that have been received on ERA files • Find which report layout works for providers • Take opportunity to look at additional services customer may need – Eligibility – Clinical Claim Scrubbing

Manage Expects Tips for Training • Payer ID is Payer ID of fiscal intermediary and may not match Payer ID of claim • Largest $ amount is stored in table • Can be viewed and edited in ERA Manager • Identity items that are overcharged and underpaid

Task Manager Integration • Identify Claim Adjustment Group Codes/ Reason codes that ALWAYS need to be followed up one • Identify Claim Adjustment Group Codes/ Reason code that require no follow-up • $0.00 Paid ERA Transactions • ERA Transactions that could not match to a claim

Follow-up • Daily – Check refresh time to see if tasks are being worked

• Weekly/ Biweekly – Schedule follow-up conversation • Find out what enhancements would make product more effective

Thank you for your attendance today. Thank you for partnering with Practice Insight