• Pre-Visit Workflows (Details)

    Identifying issues in registration, financial counseling, and/or authorizations prior to the patient’s arrival has significant impact on receivables. This workflow has been implemented with v4.0 software. Integrates the applications of Scheduling, Eligibility, and ETM.

  • Claim Edits

    Do away with stacks of paper lists sorted by claim. Transitioning to ETM organizes the work and eliminates the ‘black holes’ of PCS. When users believe they resolved an edit, but it does not allow the claim to produce, ETM returns the edit to the user while in PCS the work goes undone.

  • Claim Payer Edits

    Why work these edits on the web site or even in PCS where you have totally different workflows? ETM allows the effort to remain in the system. We have developed our own method, through the use of Rulesets, to organize the work into different groups so that the edits can be distributed to the correct areas to be resolved.

  • Rejections

    Setting up the Rejection Subsystem to appropriately allocate the work is the first step in a successful ETM implementation for this workflow. Using ETM, you can transfer the responsibility of rejections (e.g. business office transfers to the charge correction team) and still have the controls in place to ensure all the work is being resolved.

  • Correspondence

    Using EDM and ETM, this workflow can be developed to route pieces of correspondence to the correct staff, automate actions based on type of correspondence, and allow accurate reporting of those current stacks of paper correspondence.

  • No Response

    Integrating the status of invoices based on other workflows, the follow up on insurance claims can be more efficient and exception based. Your staff will be following up on accounts that truly require follow up at this time. If claims are pending edits, rejections, or correspondence they will be removed from this workflow until action should be taken. Following up on a payment posted with no claim prepared at 5 days vs. an invoice that a claim was submitted 30 days ago is the flexibility that this workflow allows.

  • Self Pay Follow-up

    Integrating dunning table value with ETM efficiencies, this workflow can also be implemented to allow the flexibility to pursue collections on accounts that have the best chance of collections. And then follow that up with a modified transfer to external collection agencies with no holes.

  • Customer Service Calls

    Using the flexibility of ETM, we can establish workflows that allow a Call Center to resolve the majority of calls through appropriate instruction pane directions, indicate outcomes to allow reporting of call types, and transfer those calls that require additional resource assistance to the appropriate areas efficiently.

  • TES

    The old issues of redundant edits and staff seeing edits they have no control over is history with this workflow. Flexibility in the Preview and Instruction panes and the use of agents will improve the current workflow in TES. Enhanced reporting is also an advantage to implementing this workflow in ETM.

  • Credit Balance/Refunds

    Identifying issues in registration, financial counseling, and/or authorizations prior to the patient’s arrival has significant impact on receivables. This workflow has been implemented with v4.0 software.

  • Interface/ADT Edits

    Identifying issues in registration, financial counseling, and/or authorizations prior to the patient’s arrival has significant impact on receivables. This workflow has been implemented with v4.0 software.

Workflow Dependency Effort (1-5 scale)
1 Pre-visit Use of SCHED application 1
2 Claim Edits None 1
3 Payer Edits None 3
4 Rejections None 3
5 Correspondence Use of EDM application 4
6 Insurance Follow-up Most effective following workflows 2-5 5
7 Self Pay Follow-up None 2
8 Customer Service Most effective with all others 3
9 TES None 3
10 Credit Balance/Refunds Requires 6 1
11 Interface/ADT Edits None 3
  • Reporting

    Reporting in ETM allows effective productivity, snapshot reports, and trending reports so that you can watch the work volume decrease as you work on root cause solutions. We have developed an automated report product that provides scheduling, querying and output to a server or email distribution, all completely automated and hands-free.