The IMA Quarterly: Q4 2008 page 3
This new GUI- based program is available to all IMA users. Previously, only a legacy format ledger was available. This module includes many expanded features for lookup as well as summaries of the financial data associated with a specific client. There is also a facility to change and fix the data. You’ll find this new program in the Finance (Billing and Remittance) section of your v17 menu with the heading Client ledger.
Note that summaries by payer are automatically provided in the lower window and also the various action buttons on top. The data may be filtered by various types of payers and date ranges. Both hard copy and CSV output of the data displayed are also available
Previously the usefulness of ad hoc reporting on billing information was very limited due to “complications” arising from the different service record types that are associated with different program types. Outpatient clinic claims typically associate one billing record with each service. In other service modalities (such as CDT, Case Management or PROS) however, we may assign only a single billing record for all the services provided during the month.
These “complications” have now been resolved with the introduction to our ad hoc reporting system of a whole set of new billing- related “Special Fields”. These Special Fields are stand-ins for various summing functions that automatically take into account the different types of service records across different types of programs.
The net effect is that meaningful ad hoc reporting is now feasible on the billing database. Sign up for the December 4 Webinar to learn all about this exciting new facility and how these new Special Fields can help you extract billing information from your database exactly as your agency needs it – including providing information for the ever-present auditors.
The Office of the Medicaid Inspector General is hiring even more auditors, so you can expect continued visits from them.
Clarification is being sought regarding the August 2008 letter which advised that agencies can only bill COPS/CSP for Medicaid Managed Care claims if the claim has been paid or authorized by the Managed Care company. It is clear COPS/CSP can be billed for claims paid by the Managed Care company; it is not yet clear if a service that is authorized but not paid can receive COPS/CSP. Currently the IMA system is set conservatively to block unpaid Managed Care claims with an MB2 error.
We are hearing from our clients that careful use of information in the IMA system can result in successful challenges to OMIG efforts to re-claim money. For example, one customer was able to prove claims were actually paid by the Managed Care company and also proved that clients had SSI and thus their claims could be billed directly to Medicaid without first billing Medicaid Managed Care.
As reported in the last IMA Quarterly, we offer a special service to review the billing process on your system. We are happy to report that these visits have proved very productive. In addition to the planned-for results of streamlining the process and introducing effective monitoring and control procedures, a number of unexpected benefits were also generated.
Here are a few discovered items that yielded to an easy solution and quick improvement in reimbursement:
- Medicaid denials when clients have multiple payers.
- Claims sitting in denial status, thus missing significant reimbursement opportunities.
- Identification of Claims unbilled to any payer.
- Billing personnel with no knowledge of available financial reporting.
In these tough financial times, you can’t afford to miss any reimbursement opportunities. Email us at HelpDesk@imasys.com if you are interested in scheduling a Revenue Audit visit for your agency.
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