Fee Basis Claims System (FBCS) ™

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.



Documentation

FBCS FLOW

 

FBCS Marketing Brochure