What's in a Number?
28
Claim _____________ Process
Adjudication
ERA/EOB
What Language is our Billing Rules coded in?
JSON
What is a $0 Paid Encounter?
A full denial no patient/insurance payment
What is the number of Insurance Types that a patient could have covering them?
3 (Primary, Secondary, and Tertiary)
What does FHA stand for?
Financial Health Analysis
What is the EOB digitizing technology called?
OCR (Optical Character Recognition)
Who is our main clearinghouse?
Waystar
What does it mean to have $0 Payment?
It's a denied claim.
What is our Average Denial % across the platform?
2%
Where does the rejection come from? What is it?
The Clearinghouse. Administrative/Clerical errors on the claim that need to be updated.
How much does each paper statement cost the partner?
$1
Who creates the rules for the practice?
Denials Team/Rules Architect Team
What is a finalized denial rate?
After everything is done with the claim there's no additional actions that can be taken except push to patient. Before writeoffs.
How many Clearinghouse Integrations do we have?
5
What is the range of what practices charge compared to their contracted rate?
1.5-3x (anywhere in this range is fine)
What payment date do Accounting RCM teams primarily use for reporting?
Date Posted
What are the 5 Ps of easily explaining how we can mix and match Rules?
Practice (Facility), Provider, Payer, Procedure Code, Patient
What don't we do for RCM customers?
Credentialing, Prior Authorizations, Coding
When was Athelas founded?
2016
What is the High-Level Claim Process? (End-to-End)
Encounter Import, Claim Creation, Claim Submission, Clearinghouse, Payer, Approved/Denied, Payment Posting
What's the difference between Date-of-Service, Check Date, Bank Deposit Date, and Date Posted?
Date-of-Service is date of the encounter, Check Date is when the check was draft, and Bank Deposite date is when the actual money was deposited. Date Posted is the date the payment was posted in the actual PM/EHR system.
There are three ways we compile rules ahead of Go-Live
Looking at their EHR's Rules, Taking their Tribal Knowledge, SuperAudit 2 years of historical claim data.
If a patient paid a $20 co-pay and later received a patient statement for an additional $20, what happened?
Claim was adjudicated, but the payer determined the patient owed $40.