Maximize Revenue with athenaNet: Master the Zero Pay Review & Payment Mismatch Tracker
In today’s dynamic healthcare landscape, achieving precision and efficiency in the revenue cycle is vital for the success of any medical practice. athenaNet offers a variety of tools designed to streamline administrative tasks, improve financial workflows, and reduce errors. Among these tools, running the Payment Mismatch Tracker and Zero Pay Review regularly can significantly enhance both financial accuracy and practice efficiency.
Let’s dive into the benefits of these two practices and why they should be an integral part of your daily workflow.
1. Allowable Schedules and the Payment Mismatch Tracker in athenaNet:
Allowable schedules play a crucial role in ensuring your organization is reimbursed appropriately for services rendered. When you build and maintain these schedules accurately in athenaNet, you’re setting up the foundation to run athenaNet’s Payment Mismatch Tracker Report. The Payment Mismatch Tracker is a valuable tool within athenaNet that helps identify discrepancies between the expected payment (based on allowable schedules) and the actual payment received from payers. Running this tracker on a regular basis helps catch underbilling issues early, allowing for timely follow-up and resolution.
Key Benefits of Building Allowable Schedules and Running the Payment Mismatch Tracker:
Accurate Reimbursement Rates: Allowable schedules provide the necessary data to calculate the expected reimbursement rates for each of your unique payer contracts. By configuring them correctly in athenaNet, you can ensure that each claim reflects the appropriate and expected reimbursement rates.
Efficiency in Claims Processing: Allowable schedules in athenaNet help automate the process of applying payer-specific rates, so staff don’t have to manually calculate reimbursements for each claim. This reduces administrative workload and human error, allowing your team to focus on more value-added activities.
Improved Financial Forecasting: With accurate allowable schedules in place, your practice can better predict revenue from different payers, helping you forecast financial performance more accurately. This enables your team to make data-driven decisions about budgeting, staffing, and investment.
Faster Resolution of Payment Discrepancies: Regularly running the Payment Mismatch Tracker allows your team to identify payment discrepancies quickly. Whether it’s due to underpayment or overpayment, being proactive in identifying mismatches allows your practice to follow up with payers and resolve issues faster, ultimately improving cash flow.
Increased Revenue Recovery: Payment mismatches can lead to significant revenue loss if not addressed in a timely manner. Running the tracker ensures that underpayments are identified and followed up on, enabling your practice to recover more revenue that would otherwise go unnoticed. This helps maintain a healthier cash flow, ensuring that your practice has the funds needed to cover expenses and continue operating smoothly.
Enhanced Payer Relations: Identifying and addressing payment issues proactively shows payers that your practice is diligent and organized. This can help strengthen relationships with insurance companies, as they will recognize your practice as a reliable and responsive partner.
How to Build Allowable Schedules in athenaNet:
Start by gathering the most recent contract rates from each payer.
Build the appropriate placeholders in athenaNet’s Billing Admin > Allowable Schedules admin table. A unique row is necessary for each set of unique fees.
Import the fees into the placeholder/row that was created in the Allowable Schedules admin table. The import job will require a case with athena’s CSC. Utilize athena's Fee Schedules and Allowable Schedules Template found on the Success Community when building out the import file.
If the contract is based off a percentage of the Medicare global allowable then you may use athena’s built in calculator within the “Terms and Conditions" section of the Allowable Schedules admin table to set the payers expected allowable rates without having to import an excel file of fees
Review and update the schedules periodically to account for contract changes, negotiated rates, and updated payer policies.
Running the Payment Mismatch Tracker:
The Payment Mismatch Tracking Report is found under the athenaNet Report Menu. Once in the reporting tool you can set filters to generate data based on payment post or service date, procedure code, medical groups, provider groups, provider, department and insurance/payer categories or types.
Best Practices for Running the Payment Mismatch Tracker:
Per athena’s Revenue Cycle Best Practice Calendar this report should be generated weekly.
Run by Payment Post and Previous Week.
Export the underpayment data into an excel spreadsheet/CSV file. Utilize pivot tables to identify trends in payers and CPT codes
Notify your team of ongoing discrepancies and provide them with claim examples to follow up with the payer and request correct adjudication
Track the status of each issue and ensure that resolutions are documented for future reference.
2. Zero Pay Review
Running athenaNet’s Zero Pay Review is a crucial step for practices aiming to identify and resolve payment issues quickly. This report allows users to review claims that were processed with a $0 reimbursement, helping to spot discrepancies early in the billing cycle. By regularly running the Zero Pay Review, your team can efficiently identify potential claim errors or insurance issues, ensuring that no payment is overlooked. This proactive approach minimizes delays, improves cash flow, and ensures that your practice is reimbursed accurately and promptly. Regular reviews help maintain smooth revenue cycle operations and enhance overall financial health.
Running the Zero Pay Review:
The Zero Pay Review tool is found under the Claims Menu in athenaNet. Once in the reporting tool you can set filters to generate data based on payment post date, diagnosis code, procedure code, provider, department and insurance/payer categories or types.
Best Practices for Zero Pay Review:
Per athena’s Revenue Cycle Best Practice Calendar this report should be generated weekly.
Run by Previous Week.
Export the Zero Pay data and flag the claims that require additional research.
Notify your team of claims that require follow up.
Track the status of each issue and ensure that resolutions are documented for future reference.
Conclusion:
Building Allowable Schedules in athenaNet, running the Payment Mismatch Tracker and running the Zero Pay Review on a regular basis are powerful tools that can help your practice increase cash flow and improve your bottom line. With the right systems in place, you can avoid payment issues, reduce administrative burdens, and keep your financial operations running smoothly. By embracing these practices, your practice can streamline its revenue cycle management process and ensure that both patients and providers receive the timely and accurate service they deserve.
Are you ready to take your practice’s operations to the next level? Reach out to Ignite’s Consulting Team to hear how you can optimize your Allowable Schedule build and implement Revenue Cycle Reporting Best Practices.
