Presenter: Sheryl Easter
Organization: Nordic
Just over a year ago many of us faced the fallout of the largest cyber-attack on the healthcare industry. A report from Fox News in early 2025, stated “…cyberattack exposes 190 million in largest US healthcare data breach”. Becker’s reported on February 21, 2025, that “The attack sent shockwaves through the healthcare industry, disrupting care delivery and threatening the financial stability of hospital nationwide”.
If we learned anything over the last year, it was that organizations had become too dependent on vendors and third-party solutions to ensure clean claims through bridge routines, payer edits checks and mapping. We didn’t fix what wasn’t broken until we were scrambling to find a way to get claims out the door during the cyber-attack.
During this time did you find large bridge routines or edits in your claim’s scrubber?
Did you find maps linking to the payers built outside of MEDITECH?
Were you scrambling last year to find alternative methods to get claims out and rapidly alter existing claim builds?
Then this workshop is for you! If you weren’t impacted last year but are interested in improving your clean claims within your Expanse Claims application and reducing your dependency on third-party solutions, then this workflow is for you too!
In this workshop, we’ll provide tools and guidance to assist in improving your current MEDITECH Expanse workflow/build to help with decisions you are faced with implementing new functionality related to Claims processing. Although this session is geared for the Expanse User, the methodologies and practices can be used in most versions of MEDITECH.
Learning objectives:
- Breaking down the Claim Components: Understanding the key dictionaries for the claim components can be challenging but with proper tools, sites can implement and optimize with ease.
- Enhancing the Claim through Expanded/Enhanced Build: Maps, Sets, Account Checks, Matrix, Max Units and other advanced claims builds.
- Automating claims output and reducing denials for primary and non-primary claims submissions
- Use of Account Checks/Account Check Sets: Improve Clean Claims using Account Checks, Account Check Sets, and appropriate timing.
- Improving via Claim Matrix, Max Units, and Alt Codes: Provide tools to help organizations advance methods of improvement through claim matrix, charge matrix, max units and alt codes.
- Bring it all together through the Bill and Claims Eligibility Rules: Understanding how to bring all the claim components and improvements together through the Bill and Claims Eligibility Rule
- Minimize Denials of Secondary Billing: Understanding the key set-up for non-primary insurance billing to minimize the denials.
Sheryl Easter is a Principal Consultant with Nordic Global Consulting supporting both US and international organizations. She has over 38 years’ experience working closely with healthcare organizations to help improve their revenue cycle and financial processes, resulting in increased revenue and decreased avoidable write-offs for the facilities. Sheryl has functioned in various roles including Managing Director-Revenue Cycle & Finance, Project Manager, Senior Management Consultant, and Senior Financial Analyst working in the areas of Patient Financial Services, Patient Access, Scheduling, Materials Management, Authorization/Referral Management, Health Information Management, Abstracting, Payroll, and General Financials. Education has been a key motivator, and after achieving a master’s degree (MBA/HCM) with a large focus on healthcare. She became an educator focusing on healthcare regulations, optimizations, changes, and revenue cycle.