HEI Knowledge Center: Scanning Patterns

Hi, my name is Steven and I’m an Account Resolution Specialist for HEI.

Today we are going to briefly talk about scanning patterns. A scanning pattern, is typically what you do when you first open an account in the billing system, to quickly identify the key elements and issue for the account.

First, there are many ways to scan over an account, and many of them aren’t necessarily wrong. However, I’m going to show you my method- which has helped me to improve my productivity and quality.

Before opening an account, I think about 5 boxes (you can even have them written down) that I use as sort of a starting point that should help me to focus on what’s happening, and I will start eliminating boxes as we’re working through the account.

The primary 5 boxes are:

Payers

Claim ReceivedClaim Not ReceivedDenials

 

Payments

 

 

Let’s jump into an example:

So opening up an account in our system CollectLogix my eyes are immediately drawn to 5 these five areas:

First I see the payer is BlueCare, pulling together knowledge of the top of my head I know they’re a Medicaid program and, for us, there timely filing is 120 days from the DOS. I can eliminate that box for right now, keeping it in the back of my mind.

Then my eyes move to total charges, payments and balance. The total charges are: $1,173.11, but the current balance is $794.94 and comparing that with the payments, it’s clear that some sort of adjustment was done as there is $0 worth of payments. Which brings us back to our boxes. Now Because there’s that $0 in the payments we can go ahead and eliminate payments.

Now I check the Account Age and we’re at day 141. So using that little bit of info that I got back from the payer box (show: Medicaid, 120 days for timely filing), I look for when the claim was created: 4/1/18. This narrows down the possibilities (Timely filing for Denials, Claim Not Received – Rejection, Claim Received processing.

Now you could go a bunch of different directions from here.  Since I pulled this account into my queue 3 days after this claim was created, I’m going to open the claim up in our billing system, which shows it was accepted by BlueCare 4/2/18. I can eliminate the possibility of Claim Not Received.

Finally, pulling up Blue Care’s portal it does show that the claim is processing, but in the remarks, it shows it will deny for timely.

In summary, without really having to read any notes or having to dig deep into the account I quickly was able to identify the key elements and the issue for the account. Just remember to utilize your wealth of knowledge and information you have learned along the way.

Take what you know and formulate it into your own process of elimination system, and continuously adapt it to what you’re working on today. Creating some sort of system like the 5 boxes will assist you in quickly pinpointing the key issue going on in the account. This will improve your quality and optimize your time spent working accounts.

I mean that took me… 5 minutes to work the account… That’s a new personal best.

Thanks for watching, and I’ll catch you next time.

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