Industry experts estimate that hospitals lose between 4% and 12% of managed care revenue per year due to faulty payments and denials. Many of our client hospitals are recovering substantial sums of money using our Variance Analysis tools. Numbers reported to us range in the hundreds of thousands to several million dollars per year. We expect even better results using the Denial Management tools (new feature in 2005). In addition, many clients have reaped huge amounts of additional revenues through the use of our charge maximization tools while also saving consulting fees associated with charge master reviews.

Harvest can be installed either as a web-based product or an in-house client server application at your option. The client server installation requires that you purchase a file server and probably one or more workstations unless some of your existing workstations have adequate processors and memory. After analyzing your billing volume, we will provide you with a detailed list of Recommended Hardware for the client server option. The web-based option does not require any hardware purchase.

In the case of billing done using the conventional XX5 Bill Type, the system will automatically add the late charge items to the existing patient claim in the database that has the same account number and date of service. Late charge billing done using a re-bill function should refer to the question and answer below.

The system automatically replaces an existing claim record with a re-bill having the same account number and date of service, provided however that the existing claim record is unpaid. This protocol handles both late charge billing, and re-billing for insurance coverage changes.

Normally, within 24 to 48 hours, but no longer than 5 working days at most.

The system uses three methods to identify the correct amount of patient responsibility:
1. Capture the actual deductible or copay reported by the payor from the HIPAA 835 electronic payments.
2. Compare calculated contractual allowances to paid contractual allowances to mathematically determine the correct amount.
3. Use a Master File table in Harvest where known Deductibles and Copays can be referenced.

A client server installation requires approximately 16 weeks from initial "kick-off" meeting to final product loading and training. The web-based version of the application requires half that time or less. A detailed outline of all the installation steps and requirements can be made available to you.

Technically yes, as long as you have saved all the claim and payment data in the required format. If you are considering doing this please keep the following two things in mind.

By licensure agreement, your annual maintenance fees begin with the date of the earliest claim data in the system. This is because we have to set-up all the payment rules and fee schedules that relate to those claims and support all the system and interface issues associated with loading that data. At the same time you enjoy all the benefits of the system as though it had been installed back then. Therefore, if you back-load one or more years of data, you will incur at least one additional year's maintenance fee in the first year of installation.

Due to the significant amount of claim and payment volume, it is necessary that you first start and maintain the system with current claim and payment data then work your way backward loading data as machine and staff time permits.

Unlimited telephone support is provided Monday through Friday, from 8:30AM to 5:30 PM Eastern time.

For most hospitals using the client-server version of the product, 2-3 hours is required to load the claim records, calculate all the expected payments, load actual payments, and compute the variances. Please keep in mind that the Import Function is a fully automated, unattended function that typically processes during "off-staff hours" in the evening. For the web-based version, we at TPMS manage most of this process for you.

It depends upon the number of claims you designate in the Patient Population and the degree of complexity associated with the payment rule that you build. We highly recommend that this and other resource-intensive processes be set up to run during "off-staff hours" at night. Typically it will be done several hours before you come back to work in the morning.

Harvest contains a specialized tool for analyzing and monitoring payor denials. Based upon the use of the HIPAA-mandated ANSI 835 payment transactions, the system captures all claim adjustment codes at both the claim and service line (charge) level. Specialized code management capability allows the user the ability to group codes into user-defined categories for retrieval, analysis and reporting purposes. In addition, users can map codes to named departments or areas responsible for the cause of the denial and/or the initiation of corrective action. Claims containing denial codes can be associated with user-defined issue groups and assigned a follow-up "tickler" date for timely review of corrective action.

The two most common locations for the system are either in Finance or the Billing Office. We recommend the Billing Office due to the daily interaction between the system operator(s) and the billers. At the same time however, "ownership" and control of the system is very often with Reimbursement or Managed Care.

That is dependent upon the size of the system configuration in terms of the number of facilities and provider types. A minimum of 1.0 FTE is necessary to handle the day to day functions such as loading and reconciling data, claim edits, report generation, etc. Organizations with multiple facilities or those having one or more large group practices will naturally require additional FTEs. In addition, some hospitals have developed Revenue Cycle Management teams that are dedicated to the process of identifying and recovering payment variances. Hospitals that are most successful in recovering money typically have 1.0 FTE per 150,000 claims per year in their team.