Ep. 13: Billing is Thrilling 2.0 [TRANSCRIPT]

Abby Rose Esposito, Sr. Marketing Strategist (00:11):

Hello and welcome back to the MediSked podcast. I am your host Abby Rose Esposito, senior marketing strategist at MediSked. Kristy Love is back and better than ever. Medisked’s EDI program manager is back for round two of billing is thrilling. We’ve got some new questions about billing for home and community-based services. So this episode is going to be even more thrilling than the first. Welcome to the podcast, Kristy.

Kristy Love, EDI Program Manager (00:40):

Thank you.

Abby Rose Esposito, Sr. Marketing Strategist (00:42):

So first of all, we should have covered this last time, but what does E D I stand for and entail? What does your day-to-day job look like?

Kristy Love, EDI Program Manager (00:52):

That is a common question I get from friends and family. So EDI is electronic data interchange, so that is essentially computer to computer exchange of business documents in a standard electronic format between business partners. So any moving parts of paper based exchange between businesses that can be done electronically. Businesses gain benefits such as reduced costs, increased processing speeds, reduced errors, improved relationships with business partners. So to do that at MediSked we hold BAAs they call it with our clients, which is a HIPAA privacy rule that outlines responsibilities that each party has in managing PHI or EHR data set. The BAA states that both parties will appropriately safeguard the protected health information being handled and keep unauthorized users from accessing any PHI data that we’re transferring over the electronic data interchange. So anything that’s moving over the electronic part over the cloud, we just send over.

Kristy Love, EDI Program Manager (02:04):

It’s nice. Nothing’s on paper of what we do here at MediSked. And as for what I do day to day, what I really like is everything is different most days. I get to work with internal teams and external clients to ensure that the med product and service offerings meet the needs of our clients for all of their billing needs. I get to coordinate with clearinghouses payers and configure interfaces and files to complete generations and submissions for them. Some days I get to tap into project management skills and work directly with the implementation team to get all of this done during any product trainings.

Abby Rose Esposito, Sr. Marketing Strategist (02:45):

Awesome. How can payers use data and analytics to improve claims reimbursement?

Kristy Love, EDI Program Manager (02:54):

I would say by leveraging data and analytics, organizations can get insights into payer specific behaviors and use historical data to predict when claims will be paid. This can be helpful for healthcare leaders to manage the revenue cycles and processes in forecast any revenue and also correct issues even before they occur. This improves care coordination also through the health insurance exchanges. Other means of data sharing. Payers can access information that will help them establish preventative and wellness guidelines to identify areas which fraud and waste can be eliminated and targeted, which we also do EVV kind of too targeted on that.

Abby Rose Esposito, Sr. Marketing Strategist (03:43):

Got it. Okay. So what should payers look for in a vendor to optimize payment accuracy?

Kristy Love, EDI Program Manager (03:50):

I would say that managed care contracts are most successful for human service organizations when every employee completes their tasks, not only accurately but also in a timely manner. Therefore, providers and medical coding companies must have the right systems and processes in place to ensure their coding resources are kept up to date. The organization also needs to make sure that the employees are continuously updated with the most up-to-date coding rules and regulations by ensuring billing and coding compliance. Medical claims will be reimbursed faster. Having the right software solution can do so much of this for you.

Abby Rose Esposito, Sr. Marketing Strategist (04:29):

Awesome. So how does MediSked empower providers to submit accurate and complete claims?

Kristy Love, EDI Program Manager (04:36):

There’s actually so many different facets within the MediSked platforms that help with this. Within the more information page for service payer and consumer, there are different guardrails that will help either hold back claims to be fixed before they need to be sent or once they are completed or filled out to help them go out. Also auditing claims. If there needs to be a percentage of claims that need to be audited before they go out or not at all or all of them that will help submit accurate claims. Also, if we need to make sure that every single claim has an authorization on it, if every single claim is going to need an admission date, there are so many different facets on the MIPs or what we call a more information page that contain data from location to provider to the payer of what and where the service happened.

Abby Rose Esposito, Sr. Marketing Strategist (05:38):

Yeah, a lot goes into this <laugh>. I’m glad that we have you to handle this. Well, Kristy Love, do you have anything else to share with our listeners before we let you go?

Kristy Love, EDI Program Manager (05:49):

I think I have to always say that billing is thrilling and if anyone ever has questions, never hesitate to reach out. Billing obviously does seem consuming and confusing, but it really isn’t that hard and keep on keeping on. Awesome. Thank you so much.