Patient Access Management Components

Registration Guidance

Registration-based data quality issues represent a significant source of claim payment denials. At the same time, many of these errors are some of the easiest to correct if caught during the course of registration. CareMedic's Registration Guidance works seamlessly with your existing registration system and current patient intake processes to ensure that the data captured is accurate and complete. Context-specific rules verify that the data entered is correct, and users are prompted to take corrective steps when action is needed. Specific scripts and verbiage are managed by the hospital to ensure that the information presented meets with organization goals and objectives. The end result is cleaner data intake, a better customer experience, and reduced denials from downstream billing.

Eligibility Verification
Insurance benefit verification is one of the cornerstones of an effective patient registration process. Unfortunately, it is also one of the most overlooked steps because of the traditionally cumbersome approach to obtaining the needed data, variability in payer responses, and lack of systematic workflow and reporting when the response indicates a lack of coverage for the patient. CareMedic integrates real-time and batch eligibility verification into Patient Access Management's concurrent registration process, as well as its pre- and post-registration workflows and reporting. By tightly weaving this core transaction into the system's process flows and using the resulting information for the Financial Clearance module, CareMedic ensures benefit verification on every account and--as importantly--that the information received in response drives activities that bring dollars to the bottom line.

Compliance Checking
Through medical necessity checking prior to rendering services, Compliance Checking plays an integral role in your efforts to promote accurate Medicare billing information and regulatory compliance. It simultaneously verifies medical necessity for Medicare Parts A and B outpatient services prior to their provision, and imports charge master and other information. Its HL7 interface provides automatic real-time updates to provider and patient data, including both demographic and diagnosis-related information--saving you key strokes and time. It improves compliance and reimbursement with regular updates to CCI and OCE edits, modifiers and codes.

Financial Clearance
Hospitals need to quickly and effectively identify expected patient balances, understand the patient's propensity and ability to pay, and work through effective financial clearance and counseling steps to drive up-front collection activities. CareMedic's Financial Clearance module, developed in collaboration with Cleveland Clinic, provides streamlined workflow, easy-to-understand visual cues and configurable dispositions to help the patient access staff manage clearance activities. Your staff members can quickly ensure that all self pay amounts are understood and authorized, and that a plan for payment is in place prior to the patient's admission to the facility. Integration with price estimation, demographic and credit validation further powers the functionality of the Financial Clearance module.

eFR for Access Management
Powerful eFR-based workflows help to drive pre-registration activities. Post-registration data quality checks ensure that any information missed or mis-captured during registration is brought to the user's attention prior to the end of a patient's episode of care. Eligibility response data drives workflow, and dashboard-based Key Performance Indicators (KPIs) provide management with mission critical productivity, quality, and collections information.

It's all in the network

Patient Access Management
Compliance Checking
Performance management dashboard

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