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Information that allows you to react quickly
QUICK LOOK: Episode Alert™ is a suite of reports that enables Medicare certified Home Health agencies or any Medicare provider such as Hospice, DME companies, etc. to quickly review their entire census in "real time" with information directly from CMS, to determine ongoing eligibility, HMO intrusion, MSP claims issues, PPS episode updates, Data entry errors, claim status, so called "T-file" problems with claims (Suspensions, Rejections, Approvals), financial information regarding processed claims, and daily cash reporting. Since all Medicare reimbursed entities are all processed through the same source, Episode Alert™ is capable of providing the same invaluable information to Hospice programs, DME companies, hospital claims systems and even physician practices.
THE PROBLEM: Typically, Medicare providers such as Home Health agencies or practices rely on the "free" programs provided by the Federal government to not only conduct eligibility inquiries, but also to process claims, check on claims status, and correct claims in suspension or rejection. Because this is basically a manual process, conducted one patient at a time, and typically over an unreliable and costly dial up connection, the process is not only labor intensive, but overwhelming in large practices or agencies by the sheer volume of inquiries that need to be performed.
As a result, many claims are not checked regularly, or worse still, not checked at all resulting in serious cash flow issues due to rejected claims, suspended claims, rescinded revenues due to errors, or claims made by the agency for a patient that has already opted into an HMO. Additionally, HMO's nationally are becoming increasingly aggressive in marketing Medicare-eligible seniors because they often provide better benefits than traditional Medicare. Agencies rarely re-check eligibility status until the end of the certification period.
If for example, a patient has an average HHRG score that reimburses the agency $2300 per episode, and that patient opted into an HMO early in the episode, the agency receives none of that PPS payment or it is revoked. Research conducted with our customers currently using Episode Alert™ averaging a monthly census of 500 or more patients has shown a minimum of 16-25 problem cases identified on the first run of the HMO report. That translates into $36,800-$57,500 savings which easily pays for an entire year of the service in the first month.
THE RESULTS: Here are a few testimonials from some of our existing customers:
"...With the Data Entry errors report, mistakes are caught quickly now, within 7 days rather than 60..."
"Episode Alert has increased the cash flow of Nurse on Call Florida markedly. Each Episode Alert report is invaluable in its own right, for instance the HMO report has reduced un-billable visits to almost none, while the MSP report has allowed us to generate the correct paperwork right from the start to bill properly.
With the Data Entry errors report, mistakes are caught quickly now, within 7 days rather than 60 and everyone has their eyes looking for errors. Episode Alert is an integral financial tool of Nurse on Call Florida, saving time while most importantly increasing cash flow."
Jamie Hynes, CFO, Nurse on Call Florida
"...Episode Alert finds mistakes after the initial certification check but before first billing..."
"Episode Alert reports are real time savers. The entire Episode Alert report suite reduces the FTE time spent researching, checking, following up as corrections are already identified in the reports. Especially important to my billing department is the that Episode Alert finds mistakes after the initial certification check but before first billing - errors that normally wouldn't be found until after initial billing.
Episode Alert gives Nurse on Call Florida cleaner claims, which reduces our rejected claims, making for less resubmission of claims to do, netting faster return on reimbursement."
Nashica Wilkinson, Billing Manager, Nurse on Call Florida
"Every other vendor I know takes my money, Episode Alert keeps making money for me."
Brandon Blake, CFO, Hospital Without Walls
"...the patient error report has saved countless hours of checking stagnant claims..."
"Just wanted to take a minute to thank you for your help over this past year with my IT issues and particularly wanted to remark on the Episode Alert Reports! It would be difficult to single out one of the reports as my ultimate favorite. The PPS report has been a single solution to the complex problem...particularly when "Open Enrollments" start flowing into the DDE system. In the past we had many clerical folks checking every week or 2 for potential changes in coverage. MSP-always an issue-especially when attempting to train new staff to identify those times when the patient has Medicare but another insurance in primary for a variety of reasons.
HMO report here in my area-with the environment and complexion of traditional MCR vs. MCR PFFS plans and MCR HMO's this report has given us an opportunity to accept referrals that may have been declined. It has also provided a much needed 'edge' for the liaisons as they speak to their potential referrals sources. One last remark-the patient error report has saved countless hours of checking stagnant claims and attempting to determine the reason(s) that the claims have not been processed.
The combination of the above reports have greatly enhanced our ability to bill timely, enhance collections and reduce (in multiple ways) the time spent on troublesome claims. Aside from (again) saying THANKS! I am not sure how else to express our appreciation for the Episode Alert Reports that have been such a great help to me and my billing team this past year!"
Sandy Schiffauer, RN, BSN, MS, VP of Operations Mid Atlantic/Midwest, OMNI Home Care
"...It is a billing dash board that allows for quick assessment of billing needs..."
"Episode alert that is offered by OOTBS has been extremely beneficial to all of us at Omni Home Care. The weekly report allows for a review in 5 different categories all of which can save you time and assist you with reimbursement. They include Error report, MSP report, PPS report, HMO report and lastly the New claim status report which includes RTP claims. It is a billing dash board that allows for quick assessment of billing needs. By reviewing each of these report it will stop unnecessary billing errors and you can correct billing issues immediately. This has been a wonderful, easy and helpful tool and I would encourage all providers to use it."
Joyce Wilson, RN, VP of Operations - South Florida, OMNI Home Care