MediScan EOB Payment Auditing System
- Low Risk, High Yield Return on Investment
- Reduce EOB data entry staff 50 - 80%
- Reduce EOB research staff 75 - 90%
- Increase cash flow
- Reduce claim resubmission costs
- Reduce number of Accounts Receivable days
- Provide detail for payer contract negotiation
- Minimize write-offs
- Interfaces to mainframe systems for automatic posting to A/R
Overview
MediScan's Payment Auditing System (PAS) is an automatic EOB line item posting module designed to reduce FTE costs by automating the posting decision process while generating data that can be used to support rebilling, write-offs, adjustments, and contract terms.
PAS extracts EOB data from Electronic Data Files, or from printed EOB documents using scanning/OCR technology. PAS integrates with mainframe billing application databases, and cross-references EOB and invoice data fields to extract information required for reimbursement analysis. PAS reduces the number of manual decisions required for claims processing. Payment exceptions are automatically adjudicated through the use of generic and specific rule sets. User-friendly edit screens allow the operator to manually correct, write-off or re-invoice transactions that are not attached to a specific rule set.
A traditionally held belief is that it isn't Accounts Receivable if it's a write-off. We feel that artificially decreasing Accounts Receivable measurements by discounting write-offs distorts your financial outcomes and could result in analysis that leads to attempting to correct the wrong problem. PAS is designed to maximize hard dollars by overturning denials and underpayments through application of rule sets and contractual agreements.
Justification for Including EDI Transactions
Specific rule sets are user-definable rules relating to each payer contract. Decisions can be made automatically, resulting in consistency in how the data are recorded, such as, re-invoice, write-off, etc. In addition, since the system has extracted each detailed invoice from the Accounts Receivable System, line item posting can be performed. For those payers who merely remit with a grand total and no detailed distribution of dollars according to CPT codes, the system can be programmed by the user to allocate a percentage of the total dollars received to each line item.
EOB Auditing Summary
PAS uses Windows NT or Windows 2000 Server environments and can be installed along with the MediScan Charge Capture System application (MCCS). Depending on volume, the cost of additional equipment is minimal. FTE reductions can be forecasted based on the automation of decision-making processes. Exceptions can be adjudicated in a matter of minutes, resulting in improvement of cash flow and reduction of number of days in Accounts Receivable. Payer contracts and fee schedules can be quickly updated based on the reimbursement history contained within MCCS.