Centricity EDI Product Overview
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The document outlines the features and benefits of General Electric's Centricity EDI Services, specifically focusing on the Hosted Claims Manager and Denials IQ solutions. These tools utilize advanced algorithms and clinical editing to help healthcare organizations reduce claim denials and improve revenue cycle efficiency. A case study demonstrates significant improvements in claims processing for a healthcare provider, highlighting decreased rework and faster payments.
Centricity EDI Product Overview
- 1. CEDI: Hosted Claims Manager and Denials IQ 1
- 4. Today’s Presenter Claire Wright EDI Business Development Claire Wright joined IDX/GE back in 2005 as an EDI Support Engineer. After several years, she transitioned to a Centricity Practice Solution EDI Migration Project Manager where she worked very closely with new EDI customers and was a key point of contact for EDI product demonstrations. After many years as a Project Manager, Claire joined the EDI Business Development team in 2014 in order to continue her commitment to helping new customers grow their business. She works out of the Burlington VT office – home of the EDI Data Center.
- 6. Product Overview: Hosted Claim Manager
- 7. Product Overview: Denials IQ Powerful algorithm analyzes claims data weekly to provide dashboards that reveal denial trends by code, payor, physician, location and a number of other categories, allowing the clinic to rework denials in bulk and set rules via HCM to prevent these denials in the future.
- 8. Imagination at work. Centricity™ EDI Services Hosted Claims Manager and DenialsIQ™
- 9. ©2016 General Electric Company This does not constitute a representation or warranty or documentation regarding the product or service featured. All illustrations are provided as fictional examples only. Your product features and configuration may be different than those shown. Information contained herein is proprietary to GE. No part of this publication may be reproduced for any purpose without written permission of GE. DESCRIPTIONS OF FUTURE FUNCTIONALITY REFLECT CURRENT PRODUCT DIRECTION, ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE A COMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITY REMAIN AT GE’S DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLE REGULATORY CLEARANCE. * GE, the GE Monogram, Centricity and imagination at work are trademarks of General Electric Company. General Electric Company, by and through its GE Healthcare division.
- 10. Agenda • Hosted Claims Manager Benefits • Workflow- where does it fit in • Demo • Reports • Case Study • DenialsIQ • Intro to DenialsIQ • Dashboards • Pattern Strengths • Pattern Details
- 12. PREVENT 12 Source: The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series (2009) The best way to REDUCE clinical rejections and denials is to PREVENT them before they occur!
- 13. Hosted Claims Manager Overview Proven • Proven, industry-leading clinical editing engine (including LMRP/LCD) • Includes over 4,000,000 pre-built rule combinations Real time response • Clinical edits are integrated into the approval process Continuous improvement support model • Regularly scheduled rejection and denial reviews are a key part of service Payer edits • Edits can be created specific to your local payers guidelines • Medicare LCD/NCD edits automatically updated bi-weekly for you • Edits can be turned off if not needed Submit Correct Scrub
- 14. Hosted Claims Manager: Features Claim criteria HCFA – 1500, Primary insurance, paper & electronic Claim Scrubbing Compares lines on the claim Patient history scrubbing – current claim lines along with history PQRS Scrubbing will take place on measures you bill for ICD-10 compatible Scrubbing will take place on ICD-9 and ICD-10 codes
- 15. Demo
- 16. Hosted Claims Manager: Demo 16
- 17. Hosted Claims Manager: Demo 17
- 18. Hosted Claims Manager: Demo 18
- 19. Hosted Claims Manager: Demo 19
- 20. Hosted Claims Manager: Demo 20
- 21. Hosted Claims Manager: Demo 21
- 22. Hosted Claims Manager: Demo 22
- 23. Hosted Claims Manager: Demo 23
- 24. Hosted Claims Manager: Demo 24
- 25. Hosted Claims Manager: Demo 25
- 26. Clinical edits...What are they? DLP Identifies items entered on one or more claims that have identical Dates of Services, Procedures , Modifiers, Departments, and Providers (including previous claim history) NPT Identifies where a new patient E&M was billed and the patient has been seen within 3 years by the same organization and specialty GFP Identifies an E&M that was billed during the global follow up period of an earlier procedure, has the same primary dx and was performed by the same provider NPD Identifies a line item that contains a diagnosis code that is not appropriate for use as a primary diagnosis code LBI Identifies that no diagnosis on the claim line supports medical necessity for the procedure billed (as specified by Local Medicare Guidelines) MOD Identifies a line item that contains a modifier that is not permitted for use with a particular procedure code MFD Identifies situations where you have exceeded the maximum allowed frequency for a given procedure within a given date range INJ Prompts you to add additional procedure code for if appropriate
- 27. Hosted Claims Manager Dashboard Reports
- 28. Flag Summary for Last Calendar Month
- 29. Flag Summary for Last Calendar Month
- 30. Case Study
- 31. www.CHORTHO.com Located in Tampa Bay Florida Orthopaedic division at All Children's Hospital John Hopkins Medicine
- 32. Results with Hosted Claims Manager Decreased claims rework by over 50% Reduced or eliminated clinical denials Helped speed payments by up to 22% A customizable pre-claim clinical editing and proactive claim analysis solution: Helps increase revenue cycle efficiencies Help improve claims accuracy Assists with regulatory compliance Outcomes1: 1. Representative results realized by Children’s Orthopaedic and Scoliosis Surgery Associates, St. Petersburg, FL. Reduce rejections before they occur
- 33. DenialsIQ Overview Title or Job Number | XX Month 201X See tutorial regarding confidentiality disclosures. 33
- 34. 2% Denials write-offs equaled of net patient revenue Re-working claims cost per claim $15-25 An Advisory Board revenue cycle benchmark study reported that in 2013 76% of hospitals’, (in the report) denials write-offs to bad debt, equaled 2% of net patient revenue.
- 35. How are denials impacting your performance? 2,000 denied claims = $50,000 34,000 denied claims = $850,000 $4m NPR = $80k $45m NPR = $900k A NPR = Net Patient Revenue Re-work cost = $25 per claim
- 36. DenialsIQ surfaces unseen patterns to help capture missed opportunities 36 ImproveRevenue Reduce Cost Our challenge was that the trends we were working took too long to define and usually didn’t pay off, even if we fixed them. Jose Rivera Corporate Director, Physician & Professional Services Orlando Health Advanced statistical algorithms from GE Global Research identify patterns by root cause factors Refined by customers Using FastWorks methodology with four customer partners and built on Predix platform GE’s revenue cycle experience Serving customer for over 40 years, to help improve financial performance Cost of rework – MGMA. Denials - The Advisory Board “Driving the Denials Management Initiative A Renewed Focus”
- 37. DenialsIQ identifies denials patterns through root cause factors and prioritizes based on value, providing powerful insights that drive action, without research 37 DenialsIQ Where are my most costly and unexpected denials patterns? How do I fix them more effectively? A “pile” of denials, each with a reason 300 denials x 1 Trends queried based on experience, intuition With Insights “The stuff we don’t know about.” Patterns are identified automatically, can be resolved as a unit and common themes provide context without research DenialFactorsAlgorithm DynamicVisualization Invoice Count DeniedCharges Level of unexpectedness < < Traditional denial resolution approach
- 38. Improving performance with insights that translates into results Dynamic visualizations help prioritize opportunities, to work denials more quickly. Defines pattern details and root cause, to prevent future occurrences. Advanced dashboards filter, monitor and report performance over time
- 39. Leverages Centricity™ EDI data Hosted by GE Healthcare No installation cost Data loads weekly Results for last week, last month, and current month to date Requires Centricity EDI clearinghouse DenialsIQ specifications and FAQ’s 39
- 40. Dynamic visualizations display patterns Color indicates the rate of the denials, i.e. red equals denials that are occurring more frequently than other denials within the timeframe Pattern #7 17 denials within pattern $167k in denied charges # of factors contributing to a pattern; the common reasons within the denial pattern; i.e. location, insurance, reason code Tool tips display the specific circumstances of the denial pattern; i.e. Shelburne Office, UHC, PR 27
- 41. Dynamic visualizations display patterns #7 17/$167k # of factors contributing to a pattern Algorithm results indicate level of pattern “unexpectedness” Pattern #7 17 denials within pattern $167k in denied charges
- 42. DenialsIQ Demo
- 43. Summary
- 44. Think about it…… 44Source: The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series (2009) $2 5 Average cost per claim for rework
- 45. DenialsIQ and Hosted Claims Manager 45 Hosted Claims Manager is an ideal complementary solution to DenialsIQ, our advanced analytics solution that uncovers unseen trends based on your claim denials. Uncover coding patterns/denials in DenialsIQ then look to what can be resolved with Hosted Claims Manager to prevent future denials and rework; thus creating a closed loop solution.
- 46. Pricing Overview: Bundle #1: Hosted Claims Manager and Denials IQ Bundle #2: CEDI Claims, Remit, Eligibility 43 % Savings 13 % Savings Bundle #3: Full CEDI Program 26 % Savings
- 47. > Resources • GE CEDI Information including case studies and brochures lindah@healthcosystems.com jasonp@healthcosystems.com For product questions and information: For pricing details and questions about your current EDI tools: