Working to Maximize ASC Reimbursement (Part 2): Information Systems
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- 3. • Equipment - Age of computers - Printer age and compatibility with software • Software - Specific to ASCs - Clearinghouse compatible - Security levels 3
- 4. • Increasing complexity of electronic communications: - presents challenges in multiple areas . connectivity . clearinghouse . software - expensive to keep up with changes - requires more sophisticated electronic “know-how” - time consuming 4
- 5. • The speed and dependability of your connectivity is directly related to the timeliness of your reimbursement • Types of connectivity 5 ISDN - Integrated Services Digital Network VDSL - Very High DSL B-ISDN - Broadband ISDN Cable - Broadband Internet Connection DSL – Digital Subscriber Line Wireless Internet Connections ADSL - Asymmetric Digital Subscriber Line T-1 Lines – Leased Line ADSL+2 - ADSL Extension Bonded T-1 SDSL - Symmetric Digital Subscriber Line T-3 Lines – Dedicated Leased Line OC3 - Optical Carrier Internet over Satellite
- 6. • Reliance on electronic connectivity is essential in most areas of billing / collections - Internet - Clearinghouse - Direct entry sites - Claim status sites (collections) 6
- 7. • Regular back-up procedures • HIPAA compliant connectivity • Virus protection software • Management should: - set up security levels in software - establish online insurance accounts - maintain list of passwords for all accounts and employees (HIPAA) - cancel access when employee leaves employment 7
- 8. • With the exception of direct entry, most claims are submitted via a clearinghouse • Clearinghouses are electronic portals to payers which: - assist in submitting clean claims by scrubbing (reviewing / correcting simple errors) - returns claims for correction if scrubbing unsuccessful - submits claims to payers - provides reports on claim status 8
- 9. • Not all payers are connected to all CH, i.e., claim may be submitted through intermediary CH with different claim requirements • There are various points where claims can get “stuck” both to and from payer Software ↔ Clearinghouse ↔ Payer • Electronic lingo is sometimes difficult to interpret Example: Sometimes rejection reports are delivered in “non-human readable” language 9
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