Charity Care Processing and Reconciliation Services
Get Paid Now for Your Charity Care Services

In light of recent news announcing New Jersey's 53% increase in Charity Care funds, there is no better time than now to get paid on your Charity Care services. Gaffey + Associates continues to successfully help New Jersey hospitals submit and reconcile their Charity Care claims.

We process UB92 Inpatient and Outpatient claim data for submission as Charity Care claims and remittance vouchers, providing comments and notes for priced and denied Charity Care claims.

We generate Charity Care Reconciliation Reports the last week of every month. The reports capture the previous months' Charity Care remittance data, sort the data, and identify claims that were denied and not subsequently paid.
• Report 1 - Lists claims that were previously submitted, denied and not subsequently paid or denied on any remittance (hence, not resubmitted).

• Report 2 - Using a list of patients written off to Charity Care, as provided monthly by the hospital, this report lists patients that were written off by the hospital but a claim was never submitted.
Furthermore, Gaffey + Associates is pleased to announce:

All held claims for Unisys, with Charity Care in the secondary or tertiary position (i.e. FL50b or FL50c) can now be downloaded and sent from GEMS in HIPAA compliant format.

Do not let this opportunity fall through the cracks. Invest the time and resources you need to submit and reconcile your Charity Care claims today. Take the next step and contact our Sales department at 925-226-1800 or send an inquiry to sales@gemsedi.com.

GEMS Features
Medicare 72 Rule Overlap
Medicare 24 Hour Re-Admission

GEMS now provides assistance in identifying Medicare claims that may have an overlapping scenario. GEMS can identify claims meeting the following criteria:

• Outpatient/Inpatient overlap
• Outpatient/Outpatient overlap
• Inpatient/Inpatient overlap

GEMS will halt these claims and identify conflicting claims, allowing your staff to review them prior to submission to Medicare.

If you would like to implement this new feature, please contact our Helpdesk at 925-226-1800.

GEMS Medicare Edits
Enhanced in accordance with recent changes announced by CMS*

To promote and ensure clean Medicare claim submissions, the following edits are now included in the GEMS software. These edits were implemented on July 6, 2004:

• For all outpatient claims, all line items must contain a date or dates of service for each revenue code or it will be rejected.
• Any outpatient claims containing Covered Days (QTY Segment) will be rejected.
• All claims will be edited to ensure all Health Insurance Prospective Payment System (HIPPS) Rate Codes used with a "ZZ" qualifier are accepted (not just HIPPS SNF rate codes).
• All claims containing a NPP000 UPIN will be rejected.
• All claims containing an invalid E-Code (an E-Code not listed in the external code source, referenced by the HIPAA 837 institutional implementation guide) will be rejected. Note: Medicare does not require or use E codes, but if they are sent, they must be valid.
• All claims that contain healthcare provider taxonomy codes (HPTCs) must have HPTCs that comply with the implementation guides or they will be rejected. Note: Medicare does not require or use taxonomy codes, but if they are sent, they must be valid.
• All HIPAA X12N 837 claims that contain revenue code 045X, 0516, or 0526 must also contain an HI02-1 code of "ZZ" along with a HIPAA-compliant "Patient Reason for Visit" diagnosis code or it will be rejected.
• All inpatient claims must contain the admission date, admitting diagnosis, admission type code, patient status code, and admission source code or the claim will be rejected. Medicare previously did not require these elements on 12X or 22X bill types, but now they will be required.

* CR Transmittal # 107

Customer Spotlight
Dana-Farber Cancer Institute

Dana-Farber Cancer Institute (Dana-Farber) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. The July 2004 issue of U.S. News & World Report ranked Dana-Farber as New England’s top cancer hospital, for the fourth consecutive year. It is a founding member of the Dana-Farber/Harvard Cancer Center, designated a comprehensive cancer center by the National Cancer Institute.

Dana-Farber’s Patient Accounts office implemented GEMS in July 2003 and has already seen a significant improvement in claim acceptance rates, a drastic decrease in A/R days, and a positive impact on cash flow. GEMSNews recently spoke with Dana-Farber’s Director of Patient Accounting and Information Services Manager, and asked them to talk about how Gaffey + Associates and GEMS has helped make life easier.

Since implementing GEMS in summer 2003, what impact has the solution had on Dana-Farber’s cash flow?

Dana-Farber has seen a significant improvement in cash and we attribute a large percentage to GEMS. GEMS provides Dana-Farber the ability to recognize and address errors prior to claim submission, not otherwise seen until the time of rejection. Although our Patient Accounting department has instituted multiple initiatives to improve this cash flow number, we view GEMS as one of the most important initiatives to contribute to this cash flow increase.

What effect has GEMS had on your A/R days?

Our A/R days have reduced 21% since the implementation of GEMS. Again, the GEMS solution is one of the most important initiatives behind this decrease. One A/R day is worth around $1,100,000 to Dana-Farber.

Dana-Farber uses GEMS on several desktops. How does GEMS make your billers’ lives easier and work days more efficient?

Our billers are able to view claim data online from their PC in an easy-to-view format. GEMS allows billers to view claims for accuracy and enables them to create user-defined edits to help reduce claim submission denials. This reduces the number of necessary follow-up phone calls. GEMS also supplies up-to-date HIPAA compliance checks, which allows us to determine if we have compliance modifications that must be made to our Hospital Information System.

The Dana-Farber billers were up and running on GEMS in a short timeframe. Gaffey + Associates provided excellent training services to help the billing team use the various features of the GEMS system. GEMS also has software to check claim status, which also saves billers from having to check on the status of claim payments.

What kind of experiences have you had with Customer Support from Gaffey + Associates?

Gaffey + Associates provides excellent customer support to Dana-Farber. We always receive quick and professional responses to our inquiries and requests.

Gaffey + Associates also provided weekly status meetings when we first started using their product. This allowed us to quickly resolve issues and resulted in a quick implementation of their software. Even though GEMS is working very effectively for our organization, we still have a monthly customer meeting to discuss any current issues or any additional needs that Dana-Farber may have. When we have asked for new features to help resolve business issues, Gaffey + Associates has always responded to our needs.

Talk to us about the GEMS Non-EDI solution you are looking to implement.

We are very excited about this new feature; it will allow us to retire antiquated dot-matrix printing devices that were necessary to print non-EDI Inpatient claim files. We will now be able to print these claims using a standard laser printer without manual intervention.

How would you like to utilize the GEMS billing system to its fullest potential?

Dana-Farber will continue to use GEMS to help meet our Patient Accounting goals. We are extremely happy with the GEMS products implemented to date. We will continue to use new products that are in line with the goals and needs of our organization.

What are some of the goals for Patient Accounting at Dana-Farber?

Some of our primary goals include reducing manual workarounds in both the billing/claim submission process, as well as providing automated solutions to ensure expediency and efficiency. Secondary goals include maintaining current A/R days while improving technology.

To learn more about Dana-Farber Cancer Institute, visit their website at www.dana-farber.org. For additional information on Gaffey + Associates and the GEMS billing solution, contact our Sales department at 925-226-1800.

Employee Spotlight
Customer Support Supervisor: Jason Singh

This issue of GEMS News highlights one of the most popular employees at Gaffey + Associates: Customer Support Supervisor, Jason Singh.

As manager of the Gaffey + Associates Helpdesk, Jason is often the first contact our clients reach when facing support issues. Jason averages over 40 calls a day, interfacing with every department at Gaffey + Associates in order to find the most effective resources to address customer issues as efficiently as possible.

While many organizations have lofty things to say about customer service, Jason has a very practical approach to providing every customer with the highest level of support satisfaction. He explains, “To reach this goal means to do everything in my power to resolve a client’s issue in one call.” Jason is currently working to scale up the department with additional qualified support representatives fielding phone calls.

Jason began his career with Gaffey + Associates in 1999, as a Level 1 Customer Support Representative. After one successful year he was promoted to Supervisor. Today, Jason oversees the entire Customer Support department. He has extensive knowledge of GEMS and its functionality, as well as payer-related issues, and can quickly address "just about any obstacle our customers might encounter."

"Our department needs to be proactive," Jason explains. "Our clients should not have to call us for status on support issues or updates on relevant news and information. Our goal is to reach out and inform our clients in real time. We will focus on resolving their issues as quickly as we can, with a positive attitude, so they can focus on getting paid."

Jason credits three driving forces behind his success: their names are Jaisen, Jordan and Jaden. His three sons tend to keep him rather busy on the weekends. "My boys don't believe in indoor activities," so most of Jason's time away from the office is spent coaching soccer for two of them. Any spare time that he has away from that, "I'm working on cars and listening to my favorite music."