The 3M Claim and Revenue Management Software allows you to compare coded data from the HIM department, chargemaster, UB92, and remittance advice, and helps identify the processes in the front-end of the revenue cycle that need improvement. This module imports both UB92 print images or 837I (HIPAA) data from a post-scrubbed claim and the 4010 X12 remittance advice. The import utility matches patient data stored by HIM coders with data submitted on the UB92.
When the remittance advice (RA) is downloaded, another match is made to the appropriate claim to provide a comparison between the UB92 and the RA.
The revenue management team can monitor billing changes made in patient financial services and identify changes affecting revenue. This allows you to look for the differences between pre-bill data and the bill itself. UB92 data is matched to RA data to help you determine if the fiscal intermediary (FI) made changes, and if reimbursement and contract adjustments were calculated accurately. Multiple claims and RA elements for each claim are stored in the database to provide a complete picture of how the FI responded to the claim.
After the first set of UB92 claims and remittance advice has been loaded, 3M revenue management experts arrive on-site to review the data from the combined reports and identify trends and areas for improvement. Thereafter, your organization receives an annual return visit to continue support for analyzing and using RA and UB92 data (if this component is purchased/licensed).
Key Features and Benefits include:
- Allows you to track inconsistent payments, underpayments, or overpayments from the FI
- Helps you analyze your charge structure in relation to fee schedules and APC reimbursement
- Provides an aggregated overview of problem claims to support education and training efforts throughout the revenue cycle
- Supplies a benchmark for denials management to help identify potential areas for improvement and monitor corrective action
- Provides an audit trail for back-end revenue cycle review
- Allows the revenue cycle management team to monitor accuracy and process improvements in appropriate departments
