Workflow Services by ImageMover
We have some news to share.
Workflow Services Product Update and Newsletter Vol. 3 Jan 15, 2025
Gretchen with Anthony Bolus of FMS Pharmacy in Bessemer, AL.
Workflow Services is committed to meeting the needs of our customers. We listen carefully to feedback you share and make updates as quickly as we are able. This newsletter will help you stay informed of new features in our platform and keep you updated on industry news.
In this issue you will learn more about the following:
- System Updates
- Vaccine Administration Upgrades
- Education
- When to Bill Insurance?
- Medical Billing
- Get paid for Shingles Vaccine
- Additional Resources
WORKFLOW SYSTEM UPDATES
Vaccine Administration Workflow Updates
Thank you all for the feedback you shared about the Vaccine Administration Workflow. Your Customer Success team shared your ideas with our Engineering team and they went to work to create an enhanced version of the workflow.
Click here to see the upgrades that have been made and will be available no later than January 21.. To walk through and hear a discussion about the changes that have been made, attend this month’s educational webinar on Wednesday January 29, at 9am CST. Register for this webinar here.
WORKFLOW SERVICES MEDICAL BILLING EDUCATION
Bill Insurance?
Do you ever wonder how to answer this workflow question? Or do the answer choices confuse you? Read on to learn when to select “Yes” and when to select “No”.
When asked whether or not to bill insurance, the answer depends on two things:
1. What insurance does the patient have?
2. Are you contracted with or enrolled with the patient’s insurance?
When you select “Yes” to “Bill Insurance?” a list of payers you are in-network or enrolled with appears. If the patient’s insurance is not on that list, you must select “No” and charge the patient the cash price for the service they are receiving.
Choosing the wrong payer will result in the claim getting denied and it could lead to a missed revenue opportunity for you. The claim adjudication process can take several weeks and you may not be able to reach the patient for payment once you find out the claim was denied.
It is important that you do your best to make sure insurance information is accurate. Make it a practice to collect a copy of each patient’s medical insurance card and confirm the correct insurance information is selected in the workflow. Take note of the message being displayed after the realtime eligibility check that is automatically performed on each patient.
We recommend collecting credit card information for all patients. If a claim gets denied, or gets returned with patient responsibility, we will be able to collect payment on your behalf from the patient using the stored credit card information.
Please take some time to share this information with your staff. Selecting the correct billing answers can be the difference between getting paid or not getting paid for the services you are providing.
Out of Network Billing: What to Expect
One of the first steps in getting started with Medical Billing is identifying which payers to work with and then getting contracted with those payers. This can be a lengthy process and some pharmacists don’t want to wait to start submitting medical claims. When you submit a claim to a payer with whom you don’t have a contract, you are submitting an ‘out of network’ claim. There are three possible outcomes when submitting a claim out-of-network:
- The claim gets denied. If this happens you will want to have a credit card so the patient can be charged for the service they received.
- The claim gets paid with no additional patient responsibility.
- The claim gets partially paid by the payer and the remaining balance is the patient’s responsibility.
If you are submitting claims as an out-of-network provider, it’s important to discuss the possible outcomes with your patient. Let them know that you can bill their insurance company but you cannot guarantee that the service will be covered. Discuss with them that if the service is not covered, they will receive a bill from us, your billing partner, that they will be responsible for paying. If there is a credit card on file and we receive ERA’s for your claims, we will charge the patient directly on your behalf.
There is no sure way of knowing what the outcome of the billing process will be prior to the delivery of clinical services. We recommend having discussions with your patients about their potential financial responsibilities before delivering care.
FAQ
Q: Where can I see how much I have gotten paid for a claim I submitted?
A: This information is available on the Claims page of the web portal. Updates to this page are made manually and may not be up-to-date. We are working to automate this process by connecting your ERAs to our platform. A Type 2 NPI dedicated to medical billing is needed for us to complete this work and make claim updates happen in real time.
Q: What do I need to do to make sure my pharmacy’s ERA’s get returned to Workflow Services?
A: You need to complete the enrollment process with our team and have a Type 2 NPI dedicated to medical billing that is properly configured to support your clinical needs. See this article to learn how to configure your Type 2 NPI dedicated to medical billing.
ADDITIONAL RESOURCES
Dive into our Knowledge Base
Did you know we have a Knowledge Base full of articles ready to help you level up your experience with Workflow Services? From set-up, to navigating the Web Portal, to getting started with medical billing and more - head over to our Knowledge Base for answers to all your questions any time of day.
Here are a few of our most popular articles, to get you started:
Getting Started with Medical Insurance - Collecting Insurance & Payment
Real Time Eligibility Check - What RTE does and does not mean
How to Merge Duplicate Patient Records
Thank you for staying up-to-date with the latest Workflow Services enhancements. We're excited to keep enhancing our offering to meet your needs and streamline your workflow. As always, don’t hesitate to reach out via the email below with questions or drop by our office hours for personalized assistance.
Workflow Services by ImageMover
support@imagemovermd.com