GEMS Advance Beneficiary Notice (ABN)
Software that saves time and protects revenue!

FACTS:

Laboratory procedures for Medicare patients are not always paid by Medicare.

If your hospital does not inform your Medicare patient that a lab test is not covered by Medicare, your hospital can get stuck with paying the bill.

You can protect your hospital from these denied claims by using GEMS ABN Software.

PROBLEM:

How does your registration department know whether a certain lab procedure is covered by Medicare?

There are over 100 Medicare policies nationally and by state. If you know exactly what a procedure is entitled, you will likely locate the policy on the site of a fiscal intermediary or at the Medicare site itself. But even if you found the policy, you would need to transfer the information to an Advanced Beneficiary Notice (ABN) for the patient’s signature. The time required to conduct this research and manually prepare an ABN is impractical, inefficient, and an unnecessary burden on the front-end. The front-end needs a tool that is quick, accurate, and easy to use.

SOLUTION:

Check and Print ABN’s in 60 seconds!

By entering the procedure and the diagnosis code, or a keyword, into our secure ABN web page, your registration department can instantly determine whether the appropriate diagnosis has been provided by the referring physician. If the diagnosis code does not support the medical necessity of the given procedure (e.g. a lab test), a Medicare approved ABN will print to your printer ready for your patient’s signature.

The ABN form prints instantly to any network printer and will print in either English or Spanish. Each ABN form is customized to include the hospital’s name, address, patient name, HIC number and hospital’s phone number.

The GEMS ABN Software databases contain the latest Local Medical Review Policies or Local Coverage Decision (LMRP and LCD, respectively) and National Coverage Decision (NCD) updates for your state. Plus, registration will have secure, online access to this information 24 hours-a-day, seven days-a-week from any PC with Internet access.

Notify the Business Office an ABN was issued! Expedite your Revenue Cycle!

GEMS ABN Software has a unique feature that notifies the billers in the business office an ABN was issued to a given patient in registration. If a patient’s claim is stopped for a medical necessity issue and an ABN was issued in registration, the claim is clearly marked on the report in the business office. This allows to billers to pass the claims through to Medicare with assurance that an ABN was collected. The biller can then use Condition Code 20 (Beneficiary Requested Billing) or Code 21 (Billing for Denial Notice) informing Medicare your institution realizes the services are non-covered or excluded, but requests a denial notice for the beneficiary.

GEMS ABN Software provides an easy-to-use tool that efficiently checks medical necessity and prints ABN’s. In addition, by providing the ABN to your patients, you inform them which procedures Medicare will actually pay or which procedures are not covered. Finally, it can help your hospital protect itself from paying for procedures Medicare says are non-covered or excluded.

GEMS ABN software is a win-win for patients and hospitals alike because it saves time, keeps patients informed, and protects the hospital’s revenue!

Raising Standards
by Leveraging Standards
Electronic Remittance Services

The Benefit of HIPAA Standards

Gaffey + Associates customers are realizing the high potential to reduce denials, by leveraging electronic remittance services. As more HIPAA transaction standards are put to use, like the 835-4010, today’s hospital billing office creates best practices and habits. As a result, denials are significantly reduced, progress is accurately measured, and cash flow steadily increases. Further, the entire remittance process at Gaffey + Associates is done in a secure, online environment.

How the Process Works

On a daily basis, if available, Gaffey + Associates retrieves 835-4010 files from major and commercial payers for all customers. In some cases, raw data is gathered and made available to clients wishing to process their own remittances. In most cases, however, Gaffey + Associates processes the remittance data and creates files for posting to a client’s mainframe. The posting files can include payments, denials, comments, adjustments, allowances, and other pertinent information.

Detailed Reports

The retrieval process produces detailed remittance voucher reports that help clients measure and manage denials. Customized reports are also available upon request and can include Full Remittance Advice, Paid Claims, Partially Paid Claims, Denied Claims, and Reversed Claims. All available reports can be viewed and/or exported at the Payment ID, Claim, or Detailed Claim level.

Countless Benefits

There is a tremendous amount of benefits to reap from electronic remittance advice. Having a new “use” for data, our customers can better manage and track denials, so they are ultimately prevented. Using Gaffey + Associates electronic remittance services, providers have the ability to produce an Explanation of Benefits (EOB) for patients and secondary payers. Clients can now drill down to any level of a claim to pinpoint the exact denial sources. Reimbursement and Return on Investment is maximized because detailed claim information can get exported into any denial management or contract management solution. Paper remittance advice is no longer needed, staff time is reduced and effectively redirected, and timeliness and accuracy of postings is climbing.

Raise Your Standards Today

By working with standard transactions in the revenue cycle, providers raise their standards and have a firm grasp on managing and preventing denials. Gaffey + Associates does the work and makes it easy for clients to measure progress and put to rest the risk associated with manual processing and practices. For additional information on how Gaffey + Associates can assist your remittance process, visit www.Easy835.com or www.gaffeyandassociates.com today.

Customer Service Department
“Welcome our new Customer Service Manager”

On January 30, 2006, Jeff Robertson joined the Gaffey + Associates team to fill the role of Customer Service Manager. Jeff brings a broad IT knowledge base as well as vast experience in the world of customer service. Our clients can look forward to exciting changes in how we provide day-to-day customer service. In today’s world, time is at a premium for our Revenue Management Cycle personnel.

Gaffey + Associates recognizes clients need to stay abreast of daily issues, service request statuses, industry updates, project updates, and payer announcements. Jeff will spearhead this project to improve our communication and advance our response times to our clients. If you have not yet met Jeff, I encourage you to please call our Helpdesk and request to speak with him. This is a great opportunity to introduce yourself and share with Jeff the role you carry out at your facility. If you have any special needs we should be aware of do not hesitate to let us know. Our goal is to make your job easier.

Claim History Now Available
at Your Fingertips
All you need is a secure login to our website

Gaffey + Associates now offers a complete claim history of all claims submitted through the GEMS Institutional software. All you need to do is login to our secure website, click on Claim History, and enter your patient control number. At a glance, you can view an enormous amount of information relative to that claim. Claim History documents events such as:

• Upload Date and Status
• Errors at the Time of Upload
• Date of Download
• Medicare 201 Events
• Medicare Compliance Information
• Payment Information

This is just a sampling of the data elements this feature provides. The Claim History feature also gives users the ability to download this data to PDF, MS Word, MS Excel or Rich Text format, as well as the ability for the user or manager to review the audit trail of a GEMS claim. If you do not have a secure login to our website, please contact our Helpdesk at 925-226-1800 for assistance.