CareMedic Systems

AccelerateAR MedicareRT

Efficient and Accurate Medicare Claims Processing

Medicare is the single largest healthcare services payer in the United States, often comprising 40 percent or more of a hospital’s claim volume and even a larger percentage of its revenue. Although Medicare is a good and relatively quick payer, expediting payment by just a few days can have a dramatic affect on your cash flow and financial well being. To expedite Medicare claims adjudication, hospitals need to automatically apply Medicare rules, to be able to submit claims in real time and to be able to leverage the Medicare system to assure up front that claims will be accepted and paid without delay.

The Solution

In 1997, CareMedic brought to market its real-time Medicare claims solution, now known as MedicareRT. We remain today the largest provider of real-time Medicare transaction processing serving nearly 800 hospitals with our early payment model. Our MedicareRT solution offers the ability to accommodate the recently introduced UB-04 claim format as well as the National Provider Identifier (NPI), used by payers to identify provider organizations.

AccelerateAR MedicareRT receives Medicare Part A claims from the patient accounting system, applies all Medicare required edits, such as CCI, OCE and compliance edits, and submits the claims in real time to Medicare’s online system. The claim is submitted with no human interaction, run against Medicare edits and is accepted more than 95% of the time. If the claim fails the Medicare edits, it is returned with the Medicare reason code and the biller then corrects and re-submits the claim. Receipt confirmation and acceptance errors are returned in real time from the Medicare online system and are posted directly into MedicareRT. The automated status inquiry for submitted claims allows providers to keep track of the adjudication status of the claims and is used to automate the generation of accelerated secondary claims if the claim has a secondary payer. Upon the automated generation of the secondary claim, the biller is notified that the secondary file is ready and the claim can be either locally printed and mailed or created and billed electronically through AccelerateAR™ Claims Management. Alternatively, all secondary claim functions can be outsourced to CareMedic Systems through our ResolveAR™ SecondaryGold™ solution.

MedicareRT continues to work for you after Medicare receives the claims, by checking daily for claims that may be rejected or require additional documentation, and provides the tools to manage those claims.

When used in conjunction with CareMedic’s VerifyAR Compliance Checking, MedicareRT automatically identifies claims with charges that have failed medical necessity and applies the appropriate modifiers to allow the submission of the claim, while noting the failure to billers and linking the ABN to the claim file.

MedicareRT provides a wide range of reports to identify the status of the billed and unbilled claims, provide summary information for error claims and provide summary and detailed information on claims entered directly into the Medicare system. Additionally, medical necessity reports are available as well as a projected cash report noting dollars associated with adjudicated claims.

Powerful Dashboard Capability

CareMedic’s Performance Management Dashboard is a comprehensive decision support tool designed to take data from the MedicareRT system, analyze the data, and then create Key Performance Indicators (KPI) from the data. Decision makers, at any level, need better information faster. The dashboard utilizes a combination of analytical tools, data aggregation methods, and personalized views to help maximize the revenue cycle.

The AccelerateAR MedicareRT dashboard takes a daily data feed from the MedicareRT system and converts the data into KPIs, displayed in various dashboard views. The views are set up with standard CFO, PFS, and Billing manager users, and the views can be personalized by each user.

Sample KPIs for MedicareRT:

Benefits

• Reduces reimbursement turnaround time due to the direct, real-time, automated submission of edited claims
• Improves first-time acceptance rates through application of front-end edits, including medical necessity, OCE compliance checking and eligibility, based on Medicare rosters
• Reduces return to provider (RTP) claims, which count against an organization’s Medicare billing performance and can result in a Medicare audit
• Provides an easy and timely method of identifying claims to correct and re-submit––greatly reducing the number of pending/suspended claims
• Automates the accelerated secondary claim submission to other payers based on the residual amounts due
• Automates Medicare claims status inquiries to provide users with up-to-date information
• Supports creation of note posting files to post back to the host system identifying dates and amounts of primary Medicare billing
• Supports the creation of a secondary note posting file to record the date the accelerated secondary bill is created, as well as the name of the secondary insurance, and the balance billed to your host system
• Provides easy workflow of the Medicare claims submission process from your patient accounting system to Medicare.
• Supports multiple concurrent sessions on a single PC, as well as multiple PC submissions, to facilitate high volume claim submission
• Guarantees submission of clean claims the same day they are dropped.
• Automatically retrieves the claims file, runs the submission process and submits all clean claims immediately. Billers see only the claims that do not pass the Medicare edits.
• Workflow-oriented claim printing from any claim wondow, reports area or Claims Status module
• Receives and submits National Provider Identifier (NPI) taxonomy codes and legacy identifiers
• Ability to receive 837s, UB-04s and UB-92s and provide to the payer in the necessary format to include printed and mailed UB-92s

For more information, contact us via the Web or call us at 1-800-508-8494.