The Basics on ADR
How often do we pull our ADR
What is once a week
What are the steps to pulling ADR? Where do we go first, second and third to be able to view report?
What is Warehouse reporting, then Live Data Reports, then Activity Detail report_By user
What are some cases where Revecore must refund the client the fee amount they paid? (AKA issue a fee credit)
What is takebacks (audits) , client disputes, and reporting errors
There are several reasons why we may want to report the payment in a later month. This process allows the EDI data to report, it will just reflect in Bridge reports in a later month. What are the 3 reasons?
If the EDI data reporting in Bridge needs to be reported to the client but should not be reported for the current month. Example: Working a client with a threshold for how much that can be billed per month.
If a takeback is reflecting in Bridge close to the end of the month, but the new correct payment it's associated with hasn't posted in Bridge yet.
If a payment posts close to the end of the month in Bridge but the payment isn't reflected in the client system yet.
There are only 2 Action Codes that will close a Reporting Recovery Record. Once closed, it will no longer appear in your open follow-up. What are those 2 AC?
What is DAF or DPF
What is Activity Detail Report
What areas of the Activity Detail Report_by user must your fill out before you view report? What is the start and end date?
What is the first day and last day of the current month, client, All pricing tiers, Employee type, All hospital reporting groups and your name
How does an analyst handle requesting a fee credit? What are the steps?
What is send fee request to supervisor by email and update bridge in DFM with a specific template
When you’re ready to claim an electronic payment, you’ll want to make sure you verify these things...
•Payments posted in Bridge will appear on your Month End Report. These reports are used to create the invoice sent to the client.
•Check the client system to verify the Payment is reflected in their system. If not in the client’s system, Revecore cannot claim that payment.
•Verify electronic transactions are accurate
What are some key take aways for ADR Training?
•All client system payments and takebacks should be reflected in Bridge to ensure we are only invoicing for Revecore's net gain.
•To close a Reporting Recovery in Bridge you will use either DAF - Adjusted in Full or DPF - Paid in Full.
•To report you are no longer pursuing an account, follow your Client and department requirements and guidelines.
•It is the responsibility of each associate to verify and correct payment transactions.
What weekly items are we verifying when we pull our ADR?
What is the Employee Type we pull by and after viewing report, where can you export the report to?
What is the handling and export to excel and save to desktop
An Example of a fee credit may be
January 2022
Invoiced $11,479.97
June 2022
Took back $11,479.97
Paid $7,283.25
How much is the Refund?
what is $4,196.72
An analyst prices the claim at $15,589.56. Aetna originally paid $9,359.24 so Revecore is pursuing a $6,230.32 underpayment.
During Revecore's pursuit of the claim Aetna performs a takeback of $9,359.24 and then issues $15,589.56 as the new payment.
What is this an example of?
What is net gain
Net Gain is any "new money" recovered by Revecore associates for the Client. When claiming ANY payment, it is important to verify we are only invoicing for the true gained amount for the Client.
There is a Net Gain of $6,230.32 for the client. The Analyst will only invoice for the net gained amount of $6,230.32 since the client had a payment of $9,359.24 on their books.
Should you use a checklist for checking your ADR?
Yes
True/ False
It is the responsibility of each analyst to verify claim accuracy to ensure proper posting of payments and adjustments along with accurate reason and adjustment codes
What is true
Daily Double: After exporting your ADR report, what columns will you want to check and may filter to ensure the reported amount is correct?
What is the Overpayment column and the Bls recovered amt column and can also filter the outstanding amount (column M,N and P)
Revecore obtained a payment for $143,736.17 in May 2022. Along with the payment, BCBS took back $47,331.84. The analyst added a manual payment of $47,331.84 to offset the takeback since their account was showing overpaid. The reason this showed overpaid was, the analyst did not account for the original carrier payment at the time of Recovery creation. What is this an example of?
Fee Credit Reporting Error Example
T/F : You can NOT delete EDI payments from recoveries..
What are 2 ways to prevent an electronic payment from appearing on the Month End Reports
T
•DO NOT REPORT (DNR): should be used when the EDI data is incorrect, old, or if it’s a duplicate.
•Please note that once you select DNR for a payment and the month ends/locks it in, this cannot be changed. If the payment needs to be reported after this action, a manual payment will need to be posted.
•Reporting Date: If the payment cannot be claimed in the current month, the payment Reporting Date can be moved to the 1st day of following month (ej. Payment not posted yet in client’s system).
T/F If the payment is not posted in the client system by end of month we can still claim the payment that month
F
Daily Double: Where do we go to pull our ADR weekly? And do we compare them from week to week?
What is Bridge- yes
When reviewing ADR, If the patient has not made a payment on patient liability, Revecore has the right to claim additional money recovered?
What is True
Daily Double: How do we prevent fee credits
What is check all payments, complete thorough review of all payments, reporting date, confirm any takebacks, acount for prior payments, verify and post all funds posted in client system, check all transactions
When do we post manual payments?
In a prior month, if a payment was marked as "Do Not Report" and you determine the payment should be reported, you will have to post the payment.
If you find a payment reflected in the client system which has not posted to Bridge, you can manually post the payment to close the account.
Keep in mind the way a client reflects payment transactions in their system will be the opposite of how Revecore posts transactions in Bridge. The client system will reflect payments posted as a negative dollar amount; this is because the client is taking this away from their overall balance. When posting the payment in Bridge we will post it as a positive amount, we are adding to what we invoice the client.
In a prior month, if a payment was marked DRN or Do Not Report and you determine the payment should be reported you will have to manually post the payment?
What is T