© Copyright MEGAS, LLC and Unicor Medical, Inc. All Rights Reserved. Powered by Alpha II Clinical Claim Scrubbing Through the Practice Insight Solution,

© Copyright MEGAS, LLC and Unicor Medical, Inc. All Rights Reserved.

Powered by Alpha II

Clinical Claim Scrubbing Through the Practice Insight Solution, Inc.

November 6th, 2014


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What makes a claim scrubber so important?

Why should you include claim

scrubbing in your total claim management?

Why implement a claim scrubber?


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What makes a claim scrubber so important?

• Reduce denials• It costs up to $25 to resubmit a

claim*

• Optimize reimbursement• The average monthly

underpaymentis $889*

Considering the current

economic environment,

you can’t afford not to use a

claim scrubber!

* Source - AMA


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Insurance companies are getting better at NOT

paying claims!

• National Correct Coding Initiative (CCI)

• Medically Unlikely Edits (MUEs)

• Carrier/FI/MAC Medical Review (MR)

• Recovery Audit Contractor (RAC)

• Comprehensive Error Rate Testing (CERT)

• Increased introduction of quality initiative programs like PQRS and eRx!


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Medicare Physician Quality Reporting System (PQRS)

• Beginning January 1, 2013, any eligible provider not participating in the PQRS program will receive a 1.5% reduction in Medicare payments beginning in 2015

• Enrollment in the Maintenance of Certification (MOC) program incentive qualifies physicians for an additional .5% incentive payment


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Edits

•Physicians Quality Reporting System (PQRS)•E-Prescribe•Correct Coding Initiative (CCI)•CPT, ICD, and modifier•Date•Demographics•Evaluation and Management (E/M)• Medical Necessity (LCD/NCD, FL Medicaid,

commercial, proprietary)•POS•Provider•Reimbursement•Units

What types of edits do we

offer?


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Customizable

Accounts preconfigured per provider specialty specified during

registration

Scrubs both institutional and

professional claims

Edits can be configured

by claim type

Custom edits can be created with

an advanced “edit wizard”


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Integration

Alpha II ClaimStakerPractice Insight


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a 1000 words!

is worth

A demo


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• Claims are created and then scrubbed within Practice Insight, allowing the customer to correct claims immediately before sending to the payer

• Edits can be viewed as a single claim or as an easy-to-read batch report

• Clear and concise edit messages make it easy for providers to correct claims

• Claims that do not need correction can be set to “Ready” status and sent to the payer

• Updates are done behind the scenes with no disruption to the user

ClaimStaker works seamlessly with the

Practice Insight software


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Registration options


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Demo Mode

• Provides a free one-time file scrub• Uses a live claim file from the customer• Shows the customer how they will benefit from using the

claim scrubber• Alpha II/Practice Insight may assist in the demo with your

client• Review the report and show it to client during the demo• File can be sent to customer after the demo

Registration options – Demo


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Trial Mode

• Perfect for customers who are still undecided• Allows customers to scrub 100 claims per registered provider

free of charge (i.e., 5 providers can scrub 500 claims)• Customers participate in a training session to familiarize

them with clinical claims scrubbing• We assist with training your customers• Should only be used for interested or large provider groups

Registration options – Trial


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Go Live Mode

• Customer is ready to start claim scrubbing

• This is the billable mode

• Customer participates in a training session to familiarize them with using clinical claims scrubbing

• Assistance with training your first customer

Registration options – Go Live


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Alpha II ClaimStaker will help your practice…

Reduce rejections

• Eliminate the need to re-file claims

Reduce denials

• Increase payments• Eliminate claims review processes

Ensure accurate/optimal reimbursement

• Always use proper modifiers• Always sequence codes by highest RVU• Eliminate over-coding and under-coding• Check CPT/ICD-9 combos to ensure medical necessity


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Are you ready for ICD.10?

Imagine the value of this tool on October 1st, 2014?

Documents

© Copyright MEGAS, LLC and Unicor Medical, Inc. All Rights Reserved. Powered by Alpha II Clinical Claim Scrubbing Through the Practice Insight Solution,