Medicare Compliance Checker

Registrars will have the ability to verify Diagnosis and CPT® codes for Compliance and Medical Necessity.  Hospitals will have measures in place to protect outpatient revenues and avoid unintentional fraud and abuse audits.

Advance Beneficiary Notice (ABN) Verification

If items or services may not receive payment from Medicare, registrars can produce an ABN and receive written acknowledgement from patients.  Patients will remain informed and the hospitals will measure efficiency on the front end.

GEMS

The billing office can process and submit institutional and professional (UB92 and HCFA 1500) claims to major and commercial payers.  This capability will provide a complete solution for editing, tracking, reporting, auditing, and controlling for all claims.

Advanced Medicare Editing

Incorporate Outpatient Code Editor (OCE) and Correct Coding Initiative (CCI), as defined by your fiscal intermediary.  Combined with other available edits in the GEMS billing solution, you will immediately begin to reduce Return to Provider (RTP) claims.

Medicare Compliance Checker

Registrars will have the ability to verify Diagnosis and CPT® codes for Compliance and Medical Necessity.  Hospitals will have measures in place to protect outpatient revenues and avoid unintentional fraud and abuse audits.

Reporting

Effectively manage accounts receivables with detailed online reports.  Measure errors, denials, and billed accounts from a manager’s perspective and download reports in the format of your choice.

Charity Care (Currently Available for New Jersey Hospitals)

Process UB92 Inpatient and Outpatient claim data for submission as Charity Care claims.  Minimize Charity Care write-off amounts.

Non-EDI Claim Uploading, Editing, and Printing

Gaffey + Associates makes Non-EDI Claim Processing available for business offices looking to archive, edit, print, and/or mail hard copy claims.  Our solution eliminates the need for expensive, multi-part forms and provides error identification and correction.

Claim Status

Comment Posting Back to the Mainframe
The Comment Parameters menu defines client-specific information used to create comments that may be posted to a hospital’s mainframe.  Users will no longer have to manually comment patient records.

Reporting

Effectively manage accounts receivables with detailed online reports.  Measure errors, denials, and billed accounts from a manager’s perspective and download reports in the format of your choice.

Medicare Compliance Checker

Registrars will have the ability to verify Diagnosis and CPT® codes for Compliance and Medical Necessity.  Hospitals will have measures in place to protect outpatient revenues and avoid unintentional fraud and abuse audits.

Riverbend 201 Report and Additional Development Requests (ADR) Letter (Currently Available for New Jersey Hospitals)

As stated by CMS Intermediary, Riverbend:

With the exception of the remittance advice, the 201 Report is the most important claims related report generated by the FISS system.  Produced hard copy on a weekly basis, the report has three main sections.  Two are informational in nature (processed and pending) while the “Returned to Provider” section is extremely important.

Available reports (created from Medicare 201 Status data retrieved by and stored in GEMS) include Denied Claims, RTP Claims, and Suspended Claims, and several more.  As soon as ADR Letters are available at Riverbend, we offer immediate access to these letters to reduce RTP claims, which are caused by lack of timely information requested by Medicare.

Electronic Remittance Advice

Gaffey + Associates retrieves and processes remittance advice for Medicare, Medicaid, Blue Cross, and Commercial payers in the ANSI 835 format.  Data files, such as comment and payment files, are made available for posting to hospital patient records.

Remittance Voucher Reports

Voucher reports generated include Payment Voucher by Payer by Remit Date, Denied Claims by Payer by Remit Date by Claim, as well as reconciliation reports for billers and managers.

Reporting

Effectively manage accounts receivables with detailed online reports.  Measure errors, denials, and billed accounts from a manager’s perspective and download reports in the format of your choice.

HIPAA Compliant Transactions

• Claims and Encounters: Formats 837i and 837p
• Electronic Remittance Advice: Format 835

HIPAA Compliant Transactions (Available Soon)

• Coordination of Benefits: Billing Secondary Payers
• Claim Status Inquiry: Formats 276 Inquiry and 277 Response
• Patient Eligibility: Formats 270 Inquiry and 271 Response

Healthcare Codes Sets Compliance

• ICD9-CM Diagnosis Codes
• HCPCS Codes (CMS Level II Codes)
• AMA’s CPT® Codes
• Codes Sets administered by National Uniform Billing Committee (UB92 and UB04 Forms)
• Codes Sets administered by National Uniform Claim Committee (MC1500 Form)
• HIPAA Compliant reason codes, Claims Status and Remark Codes

Healthcare Security Compliance

• Gaffey + Associates uses a combination of physical security, technical security, and administrative security procedures to maintain compliance.  All electronic Protected Health Information (ePHI) is secure before, during, and after any interchange or storage processes.

NPI

• The NPI is quickly approaching a phased implementation using the dual use strategy.  Gaffey + Associates will support the WEDI recommended dual use strategy.  To read more about the NPI and this strategy, click here.

Healthcare Edits Compliance

Gaffey + Associates software was built to subject each Medicare claim to compliance scrutiny using specific decisions tables based upon your hospital’s CMS intermediary.

• National Coverage Determinations and Local Coverage Determinations (formerly called Local Medical Review Policies)
• Medicare’s Outpatient Code Edit
• Correct Coding Initiative Edits
• HIPAA Compliant Transaction Formatting Edits

Medicare Compliance Checker

Registrars will have the ability to verify Diagnosis and CPT® codes for Compliance and Medical Necessity.  Hospitals will have measures in place to protect outpatient revenues and avoid unintentional fraud and abuse audits.

Electronic Remittance Advice

Gaffey + Associates retrieves and processes remittance advice for Medicare, Medicaid, Blue Cross, and Commercial payers in the ANSI 835 format.  Data files, such as comment and payment files, are made available for posting to hospital patient records.

Reporting

We allow our clients to generate reports including Payment Vouchers and Denied Claims by Payer, as well as Reconciliation reports.

Easy835

Get a free quote today!

Charity Care (Currently Available for New Jersey Hospitals)

Our company processes Charity Care remittance and provides reconciliation reports showing denied claims not subsequently paid, as well as claims written off but not billed.