All of our systems are fully HIPAA compliant. In addition to HIPAA, we take great care in protecting our customer data. All of our systems utilize SSL and use 128 bit encryption. We have redundant data centers hosting our servers which are fully secure. We do nightly back-ups of all data, and in the event our contract ever runs out with a customer, we can provide them with their data with 7 days of the end of the contract.
All of our tools provide a complete audit trail, detailing with date and time, all users who have viewed or documented each encounter. This includes transactions as well as view only access to the information. This audit trail can be used for compliance and accreditation reporting.
Patient Management System
Our BATCH™ calendar provides detailed insight into your facilities off-site appointments. This tool allows for simple scheduling of the appointment, and captures all appointment details. We provide numerous reports to detail access to care and timeliness of care issues. Our system manages scheduling for your institution infirmary, all on-site clinics, all off-site providers, as well as E/R and in-patient stays. Estimated costs of care are tracked within the calendar tool to help with accounting requirements.
One advantage to our system is that it is web based, meaning no software is required to be installed at the user site. This allows for the management of the patients by multiple parties at different locations. What this means is that the institution now has a choice, they can manage their own scheduling, or they can choose to have us manage it for them.
Claims Management System
We track each and every claim presented for the services provided to show when the claim was received, current status, and all contracted rate information. We have unlimited flexibility in our reporting capabilities and can meet any customer requirements such as showing where they are spending their money, what contract adjustments need to be made, and many other management type financial reports. All claim data is captured and stored in our database to be included on reports as upon request of the customer. Our claims system allows for the automated flagging of claims to be reviewed based upon criteria determined by the customer. We can decide to flag all claims from a provider if we have concerns over their billing practices, or we can flag claims over a certain dollar amount. Any criteria can be defined to ensure that certain claims get scrutinized. The system automatically identifies any duplicate claims to ensure no additional payments are made on an episode of care. In addition to our automated flagging, we provide a high level of human QA and professional review. During the first 30 days of a new contract, we audit 100% of all claims to identify suspect billing practices and or contract issues. If we identify any errors, that provider is flagged so we monitor all future claims until the issue is resolved. We will audit a minimum of 10 claims/provider during this period. If we have not received at least 10 claims from a provider, we continue to monitor all of that provider’s claims until we have looked at a minimum of 10 claims. After the initial 10 claims/thirty day period, we monitor 25% of all claims for the next 90 days. All ER/Inpatient claims over 10k will be audited for the life of the contract. Again, any issues identified during this period flag all future claims from that provider to be audited until the issues are corrected. After that 90 day period ends and for the life of the contract we audit 10% of all claims. Unless we find issues with a claim, the typical turnaround time for a submitted claim is less than 48 hours.
Once the claims have been processed, we provide detailed EOPs and EOBs for the providers and the institution. Information on the inmate, date of service claim amount, contract amount is all provided along with back up information such as a copy of the claims and reports from the processing of the claim to show that the claim has been adjudicated accurately. This leads to a quicker payment by the institution which helps in the negotiation of provider contracts.
We can provide an up front estimate on all out-patient services at the point of scheduling. Based upon the specialty, and type of procedure that is due to be performed, we can predict which Medicare billing codes will be submitted on the claim and we can provide you with the best possible estimate for the upcoming services. For E/R or Inpatient claims, we provide estimates after admitting. We will call the provider to find out the admitting diagnosis, and probable treatment program to identify which claims we will receive. We also find out what other services were utilized such as anesthesia, surgery, ambulance, and professional providers that treated the inmate. From that point on, we follow up with the provider every two days until the inmate is discharged to see if there are any complicating conditions that may affect the final DRG, or if outliers may be applied. This allows for us to provide customers with an accrual report, which can be viewed in our patient management system, to identify accrued amounts to be posted each month.