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Pre-Release: Refreshed Insurance Billing Workflows

July 16, 2020

We don’t normally publish “pre-release” blog posts, but we don’t want you to be caught off guard by some changes that are coming to Jane’s US insurance billing workflows.

We’re excited to finally be releasing these refreshed workflows that we have been working on for many months. We hope the changes will smooth out a bunch of rough spots in Jane’s management of insurance billing.

We hope you can find some time to read through the following information this week so you are well prepared (and as excited as we are!) about what you’ll be getting access to this summer.

This should take about 10 minutes and we’d recommend you forward this message to anyone who works with insurance billing in your practice.

Here’s what it will look like:

There are two main steps of your insurance billing workflow that these refreshments seek to improve:

  1. Managing Claims Pre-Submission
  2. Recording Insurance Remittances.

We consider ‘Pre-Submission’ to be everything that needs to be completed before a claim is ready to be sent off to a clearinghouse. Examples are tasks like collecting patient payment and adding your codes and modifiers. The Insurance Remittance workflow refers to managing insurer payments and EOBs (Explanation of Benefits), everyone’s favorite task.

Here’s a summary of our refreshed workflows:

Pre-Submission

Who has time to do math when trying to collect a patient’s coinsurance?

We know your busy administrative team doesn’t have that kind of time, but Jane does have that capacity.

Our support team has been peppered with the question “why isn’t coinsurance a percentage?” since coinsurance was first introduced in Jane. Well, we’ve heard you loud and clear and are transitioning coinsurance from a dollar amount to a percentage.

In order to accommodate this change, we need a way for you to enter in billing code Allowed Amounts (sometimes referred to as insurer fee schedules or contract rates) into Jane at the time of service, since coinsurance should be a percentage of what insurance allows for oppose to a percentage of what you’re actually billing the insurance company.

To make room for Allowed Amounts, we’ve tweaked the way patient insurance is presented at the time of service. The screenshot to the right shows a preview of these tweaks.

You might notice some boxes you’re used to that are missing from this screenshot. With this refreshed workflow, you’ll no longer need to worry about Eligible Amount (replaced with billing code Allowed Amounts), Max Amount (what is this anyway?), Percentage Coverage (no longer needed now that coinsurance is a percentage).

To complement these new features, coinsurance % and Allowed Amounts, this release also comes with the ability to enter Defaults Insurer Allowed Amounts for your billing codes. So, if you’re in-network with an insurance company or are just aware of what they allow for, then you can add those amounts as defaults when setting up your clinic billing codes. We’ve also piggybacked the ability to add Default Modifiers to your billing codes in this release. It is important to note that in this release you will be able to make your Default Allowed Amounts insurer-specific, but you won’t be able to create insurer-specific Default Modifiers. Our first iteration of Default Modifiers will instead be specific to the billing code and work the same across all your insurers.

Insurance Remittance Management

As you know, Jane’s EOB screen could use some love. Our team has learned a lot since the screen’s launch in 2019 and are still learning everyday. Thank you for sticking with us, remaining vocal, and inspiring us to improve.

We’ve given the EOB screen you’re used to working with a pretty significant makeover. These refreshments will allow you to record your remittances in more detail. Specifically, you’ll be able to enter what an insurance company allows for, what they’re paying, what you’re adjusting off, and what the patient needs to pay. AND you can do all of this for each code you’ve billed.

Where in the past you’ve had to lump a patient’s responsibility for all codes billed into a single box, you’ll now be able to specify what a patient is required to pay for each billing code. Likewise, you’ll be able to allocate an insurer payment across billing codes.

Why are we making these changes?

Our hope is that these changes will make you (and your biller’s) workflow simpler and more accurate.

The most exciting part of these changes is how they set up Jane for the future. These workflow refreshments set the stage for some exciting insurance pieces that we are planning to weave into Jane in the future, features like ERA Processing and Secondary Claim Submission Support.

Here’s a list of insurance billing features that we plan on designing after we’ve released the changes outlined in this blog post (most of which we’ve already started building):

  • ERA (835 file) upload and processing support
  • A new interface to document diagnosis & CPT codes within Jane’s charting
  • An eligibility check system for near-real-time patient coverage confirmation
  • Secondary claim submission support

Here’s how you can get involved:

We’ll be releasing these changes to a few select clinics over the coming weeks and more broadly to all US customers this summer. If you would like to join the beta, please email support@janeapp.com.

If there’s an insurance billing feature that you were hoping to see that isn’t mentioned in this post, please let us know! If you haven’t used it before, Jane has a feature request tool that allows you to make your voice heard in the Jane community by creating requests for features you think would be great additions to Jane, or by adding your vote to features that other clinics have requested. We have a great guide that goes over the basics if you’d like to learn more about feature requests.

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