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XClaim Suite:
Client Results >
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XClaim:
Medicare Processing
For many health care providers, Medicare is the greatest single source of revenue. That means the quality of your Medicare processing is a major determinant of your hospital's cash flow and overall financial health. XactiMed maximizes the efficiency of Medicare claims processing to reduce AR days, improve clean-claims rates and eliminate manual processes.
Medicare Direct Data Entry
XactiMed takes full advantage of Medicare's Direct Data Entry capabilities by integrating these functions within our claims management workflow. Here are some of the ways the resulting solution helps increase your efficiency and Medicare cash flow:
- Direct claims submission eliminates the wait for overnight batching and export while ensuring compliance.
- Eligibility issues and front-end errors are idntified immediately and returned, so there's no delay in resolution.
- Claim status is checked automatically within the Fiscal Intermediary Shared System, and suspended claims are returned into the biller's workflow.
- Real-time validation allows clean claims to enter the Medicare system immediately.
- Claims that have errors are automatically rerouted, corrected and revalidated, providing a complete audit trail of corrections made.
This process reduces return-to-provider claim rejections, increasing Medicare reimbursement and reducing AR days. Moreover, XactiMed captures Medicare payment data and reports expected payment, improving your ability to forecast cash.
Accelerated Secondary Billing
This feature automatically locates Medicare approved-to-pay claims and creates secondary claims to expedite processing and submission to the secondary payer.
Medicare Suspense Reporting
XactiMed automatically checks the Medicare suspense file daily and identifies all claims that have been suspended, detailing patient information, claim age, Medicare status code, Medicare location and the reason for suspense. This provides the billers and supervisors a daily view of the total number of claims and billed charges suspended at Medicare that need resolution for continued processing. Common errors can be reviewed for upstream edits or process improvement.
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