Fee Basis Claims System ™ (FBCS)
is designed to improve Fee Basis claims management and adjudication. It will bring efficiencies to the processing of claims as well as provide a knowledge base of information needed to strategically guide the decisions made about Non-VA care.
What does FBCS do for you?
Improves payment processing time
Simplifies management and tracking of Fee Claims
Reduces manual data entry
Provides standardized, repeatable processing of claims through automated scrubbing and letter generation etc.
Provides Superior intelligence needed to make a good business decisions
Reduce Fee expenditures
FBCS Workflow:
From Authorization through to payment determination, FBCS improves Fee processing by:
Presenting VistA Authorization information in easy-to-use Windows GUI screens
Providing assistance with Authorization-Claim matching through system intergration
Scanning all HCFA 1500 and UB forms ultimately eliminating paper processing
Utilizing Optical Character Recognition (OCR) technology to pull HCFA and UB data fields and automatically processing then through the integrated to:
Ensure claims are compliant with Medicare guidelines and Correct Coding Initiatives
Eliminate Bundling/Unbundling errors
Ensure medical necessaty and IDC-9 / CPT match
Ensure all codes are at ultimate speficity
Avoid overused 'generic' codes and 'catch-all' codes
Automating generation of Veteran letters and provider summary reports
Electronically sorting workload into individual work queues by routing claims to designated clerks for processing
Immediately identifying duplicate claims, claims from OIG excluded providers and claims in violation of Medicare guidelines
Identifying paid claims from Veterans with insurance
FBCS Benefits :
Provides comprehensive reporting, including:
Days to pay metrics
Clerk productivity
Claim Status Reporting
Claims paid by Type, Authorization Status, Vendor, Referring Provider
Claims Denied by Reason Code, Vendor
Duplicate Claims
Improved Customer Service:
Speeds up processing of Fee Claims
Allows for improved response to claim status inquiries
Improved Consistancy and Efficiency of Fee Claim processing:
Ensure that like claims are processed consistenly
Provides clear picture of Claim status at all times
Allows for easy claim retrieval through storage and indexing image
Savings:
Significant savings will be realized through the ubiquitous scrutiny of Outpatient Fee Claims
Efficient communication between Fee and MCCR departments will assure that insured Veteran's third party insurance is billed for Non-VA care.
