This month, we are connecting with Andy Parker, Director of Administration Services about his department projects, team, and client relations. 

What have you learned from a partner that has made a positive impact on our clients?  

For years, I managed a relationship with a partner for software that facilitated the processing of inpatient hospital claims. Working with them, we have expanded our offerings to incorporate additional software that facilitates the processing of outpatient hospital claims. This has made a positive impact for our clients by enabling them to combine pricing and process both types of claims. As we continue to grow our partnerships, we are reviewing additional opportunities to determine their advantages in use with our technology, HxPro.   

What wins has your department had recently?   

We’ve been very successful at making clients extremely efficient when it comes to adjusting large volumes of claims. It is not uncommon for Centers for Medicare & Medicaid Services (CMS) to publish a revision to a fee schedule, which can require a client to adjust claims. To streamline this process, we import and maintain Medicare fee schedules in our claims system that are published by CMS. We have also implemented CMS’ Merit-based Incentive Payment System (MIPS) program for a client, this program can increase or decrease payment based on a practitioner’s performance rating which previously required the client to adjust claims.  

Within the last six months, we have adjusted over 650K claims for a client for these reasons. Our automation has lessened the staff required by our clients to handle adjustments and has drastically improved the turnaround time.  

What should we know about your department?   

My team of six, consisting of developers and business analysts, is a unique team in that we provide dedicated full-time support to one client. This client is an administrator of Medicare Part B benefits on behalf of CMS. Much of the team’s activities involve implementations to make our claims system consistent with CMS. However, there are projects not specific to CMS programs that we design and implement for this client. My team always considers whether a project we’re working on would provide benefit to any other client within our claims system. When it can, the project is designed to function for all applicable clients. While this team provides dedicated support to one client, we always have all clients in mind when designing enhancements. 

 What are some of the new developments in your department?  

We are currently enhancing our legacy claims system for a client to perform Medicare Secondary Payer (MSP) functionality per CMS guidelines. This covers specific calculation rules to determine the secondary payment amount, enhancements to the Remittance Advice and Explanation of Benefits, as well as electronic reporting of secondary payments back to CMS via Encounter Data.    

For our clients that utilize claims editing services, we are scheduled to begin our annual optimization study. This process enables us, and our clients, to recognize potential savings. This optimization study is performed for each client and the results are packaged and shared with clients.