Gaffey + Associates  
 
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Health Care SystemRemittance and Reconciliation
for the Centralized Business Office

Gaffey + Associates working with the Saint Barnabas Health Care System

On May 9th, Gaffey + Associates announced it would manage New Jersey Medicare and Medicaid remittance, as well as New Jersey Charity Care remittance and reconciliation services for the Saint Barnabas Health Care System.

Clara Maass Medical Center
Community Medical Center
Irvington General Hospital
Kimball Medical Center
Monmouth Medical Center
Newark Beth Israel Medical Center
Saint Barnabas Medical Center
Union Hospital
Clara Maass Medical Center-West Hudson Division

The Saint Barnabas Health Care System provides treatment and services for more than 225,000 inpatients and same day surgery patients, 450,000 Emergency Department patients and over 1.5 million outpatients each year, and delivers more than 17,400 babies annually.

Gaffey + Associates retrieves 835 remittance data files for all Saint Barnabas Health Care System hospitals, processes the data, and creates posting files for patient records. Reports are also generated, reflecting payments, denials, adjustments, co-payments, and deductible amounts.

Electronic remittance services are available for:

NJ Medicare
NJ Medicaid
NJ Charity Care
Horizon Blue Cross
Aetna
CIGNA-Connecticut General
United Healthcare
NJ Health (Mercy)
AmeriHealth
Independence Blue Cross
First Health

Coming soon, payers such as Oxford Health, Empire Blue Cross, NY Medicaid, and Keystone Health will also make 835 files available. For additional information on electronic remittance advice or Charity Care reconciliation services, call the Gaffey + Associates Helpdesk at (925) 226-1800 or click here.

 
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National Provider Identifier (NPI)
CMS Opens Doors to Distribute NPI

The National Provider Identifier (NPI) establishes the standard for the unique health identifier for health care providers to simplify the administration of the health care system.

Health Care Providers (hospitals and physicians) can now apply for a National Provider Identifier (NPI) and use it on standard transactions; Health Plans and Health Care Clearinghouses must use the NPI to identify health care providers on standard transactions where the health care provider’s identifier is required. All healthcare providers should be actively enrolling in order to receive their NPI as soon as they can, so it can be provided to payers when requested.

Health Care Providers, Health Plans (except small health plans), and Health Care Clearinghouses must comply with the NPI implementation specifications no later than May 23, 2007. Small Health Plans must comply with the NPI implementation specifications no later than May 23, 2008. This is a HIPAA mandate.

  • The NPI is the unique health identifier for health care providers, and is a 10-digit numeric identifier with a check digit.
  • The NPI will replace Provider ID's assigned to hospitals and physicians that are used in FL51 and FL82,
    FL83A & B.
  • During the transition toward using only the NPI, many payers will require the NPI and the old Provider ID inside claims transactions.

To learn more about NPI and how to apply for one, follow this link: http://www.cms.hhs.gov/medlearn/npi/npiviewlet.asp

Providers can apply for an NPI by following this link: https://nppes.cms.hhs.gov/NPPES/Welcome.do

Please e-mail any questions to Seth Masters, VP of Compliance and Business Development at: hipaa@gemsedi.com.

 
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Request for Review of Diagnosis Code Information (RRDI) Letter
Now Available in GEMS

GEMS now allows users to generate a Request for Review of Diagnosis Code Information (RRDI) letter, for claims that fail the Medicare Compliance Checker (MCC). All information pertinent to the failed claim is provided on each letter, so various departments or physicians’ offices can review and ensure thorough coding of the claims. These letters will allow third parties to promptly and efficiently review the data presented and return their results to the patient accounting offices.

Benefits of the RRDI letter include:

  • The ability to print and fax individual letters to various recipients.
  • A variety of selection criteria to manage daily letter printing.
  • Clear letter templates provide an efficient means for physicians' offices to document and communicate their review of diagnosis coding.
  • Assistance with managing the population of letters that have received no response

RRDIThe RRDI Letter is a value-added part of GEMS. For information about implementing the RRDI Letter in your business office, please contact your Client Support Representative or the Gaffey + Associates Helpdesk at
925-226-1800.

Please note, the RRDI Letter feature is used with the GEMS Medicare Compliance Checker and is not a stand-alone product.


 
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Jason SinghEmployee Spotlight
Lead Supervisor Software Development: Nagarajan Punaroor

Nagarajan Punaroor is the Lead Supervisor for the Gaffey + Associates Software Development group. He is this issue's Employee Spotlight focus, and plays a critical role in ensuring the GEMS billing solution maintains optimal performance.

Naga, as he is known to his family, friends, and colleagues coordinates all software development efforts - which include the upload process for 837 institutional and UB92 claims into GEMS, complete testing of updates prior to their release, and management of Customer Support call tickets. He has contributed his expertise to Gaffey + Associates for over four years and notes the complexity of GEMS “behind the screen.” He told GEMSNews “the primary goal is to make life easier for our clients. Our team works towards the ease-of-use our customers experience with GEMS. It is very complex behind the screen, and a minor change could throw many components off track. Part of my job is to make sure that complexity never surfaces to the user.”

Normal work days are fairly intense for Naga, which makes it easy for him to enjoy weekends in the park with his son. He also takes in a movie when the opportunity arises.

Gaffey + Associates is pleased to spotlight Naga Punaroor in this issue of GEMSNews. His leadership and engineering skills help GEMS users and Gaffey + Associates staff maintain balance and momentum.

 
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Issue 6 | June 15th, 2005
In this issue
 

Remittance and Reconciliation for hte Centralized Business Office
Gaffey + Associates working with the Saint Barnabas Health Care System

National Provider Identifier (NPI)
CMS Opens Doors to Distribure NPI

Request for Review of Diagnosis Code Information (RRDI) Letter
Now Available in GEMS

Employee Spotlight
Lead Supervisor Software Development: Nagarajan Punaroor

 
 
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President's Corner
 

A Unique Approach to Patient Friendly Billing®

I am pleased to announce Gaffey + Associates was recently awarded the contract for Electronic Claims and Billing Services for University Behavioral HealthCare (UBHC), the statewide behavioral healthcare system of the University of Medicine and Dentistry of New Jersey (UMDNJ). With implementation well underway, I can proudly say both sides have already felt a positive impact - this is indeed a “win-win” situation.

UBHC is very active in helping to roll out a new nationwide initiative known as the Patient Friendly Billing® project, which will make financial communications to patients as clear, concise, and correct as possible. Asked to help provide services that fall within Patient Friendly Billing® guidelines, Gaffey + Associates has begun working with the Lions Center for the Blind in Oakland, California.

A component of Patient Friendly Billing® at UBHC includes printing and providing letters to patients, after their claim is submitted to a payer. The letter, addressed to the patient, simply states that their insurance company was billed and they (the patient) will be notified if their assistance is necessary. A large volume of letters is printed and mailed to UBHC patients on a weekly basis, and the Lions Center for the Blind will now assist us with the weekly preparation and mailing process. The project offers both a cost-effective method for UBHC to fulfill its mandate, while providing income to the vision-impaired members of the Lions Center for the Blind. It is an honor for Gaffey + Associates to contribute to its clients and its community.

Click here for additional information on the Patient Friendly Billing® project. Corporations or members of the public interested in making a donation to the nonprofit Lions Center for the Blind in Oakland can send checks to 3834 Opal Street, Oakland, CA 94609.

 
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