Stephanie Ream, director of reimbursement analysis and product development at Eveia, says that “with Medicare’s switch to a more complex reimbursement system in 2008, many centers didn’t know what payments to expect or what to collect from patients.”
As a result of this challenge, Ms. Ream says that Eveia wanted to develop a tool that could increase efficiency in the centers without requiring clients to know every bit of information about the methodology of their contracts.
The goal was to create a spreadsheet-based product that “didn’t feel like a spreadsheet.” Using the spreadsheet platform meant that surgery centers would not have to buy additional software and could use what they already had, according to Ms. Ream. Eveia also wanted staff at the centers to need only the basic information about a patient’s visit — such as CPT codes and date of service — to make the calculator easy to use regardless of a person’s position at the center or experience level.
“We wanted to make the program intuitive,” Ms. Ream says, and the company took into consideration a simple, “input in/input out” interface for the product. The current Medicare calculator allows staff to input the CPT codes for a patient procedure and the calculator automatically determines which code represents the primary procedure. The calculator addresses which CPT codes will or won’t be reduced for multiples, identifies device intensive codes and provides the logic for determination of the Medicare allowed amount.
The calculator also enables centers to determine if a CPT code is allowed by Medicare, to verify that they are not scheduling cases that are not on the approved Medicare ASC list and to ensure that they are being paid correctly as well as to train staff on Medicare’s methodology.
Once the system was developed, Eveia sent the Medicare pricing calculators to some of its clients for a testing period, asking them to use the product for whatever needs their center had. “The centers came up with uses that we hadn’t even thought of for the calculator,” Ms. Ream says.
One of these uses included helping the centers determine whether the center should schedule a procedure when physicians’ offices would call. By using the calculator, the center was able to determine how much the procedure would be paid, and if the procedure could to be performed at the center. “The physicians’ offices were impressed with how much more quickly the ASC determined whether a procedure was or wasn’t accepted by Medicare,” Ms. Ream says.
Other uses were seen at all levels in the business office, according to Ms. Ream. They included:
- monitoring collections;
- enhancing upfront collections and increase cash flow;
- calculating expected amounts due and contractual write-offs;
- determining new specialties to add at a center; and
- determining which cases should or should not be added.
Ms. Ream says that anytime a change is made to the Medicare system, Eveia will be able to make adjustments to the calculator and send the updated version to users.
Currently, the pricing calculator is available to ASCs, billing companies and corporate owners of ASCs.
For more information about the Medicare pricing calculator, call Eveia at (425) 657-0494 or send an inquiry to analysis@eveia.com.
